From Heart Surgery to Happy Pelvis: Uncovering the Surprising Links and Crucial Care Tips
Dr. Kelly Sadauckas brings her pelvic floor wisdom to the world as we explore the crucial link between pelvic health and your overall well-being in this first episode of our February series, Heart Surgery to Happy Pelvis. Dr. Kelly, with her 25 years of experience, busts the myths surrounding pelvic health issues—whether it's pee, poop, or the delicate topic of intimacy. You’ll discover why your recovery journey must go beyond just focusing on your heart, touching on why "normal" pelvic functions might be more elusive than you think, and why being pain-free isn’t just wishful thinking. Prepare to learn what your pee and poop habits say about you—in ways you never expected. With a success rate of 80% in pelvic health recovery, Dr. Kelly unveils practical tips on achieving a healthier, happier you post-surgery. This is more than just a podcast episode; it's a guide to breaking taboos and taking control of your body’s quirkiest functions. Listen in and enlighten yourself on the secret to whole-body healing.
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Time Stamps
00:00 "Heart Surgery & Pelvic Health"
04:22 Pelvic Health Awareness Journey
06:56 Pelvic Health Assessment Guide
12:34 Daily Water Intake Guidelines
14:55 Pregnancy and Poop Health Tips
18:39 Periods Should Be Pain-Free
21:09 Bladder and Pelvic Floor Explained
24:45 Rethinking Pelvic Health: Beyond Kegels
28:21 Pelvic Floor Overactivity Issues
33:01 Pelvic Floor and Bowel Mechanics
33:54 Stress-Induced Constipation Explained
40:15 Pelvic Floor Recovery Tips
42:00 Pelvic PTs Expanding Healthcare Presence
45:50 Sigmoid Colon Massage Technique
48:57 Poop Management in Healthcare
51:52 Course Discounts & Health Insights
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Transcript
A poop problem. Right. If the doctor knows about pelvic
Speaker:PT, which again, there's. Our success rate is 80%.
Speaker:So we can help four out of five people that come into our door with
Speaker:pee problems, prolapse problems, sexy time problems, poop problems we can
Speaker:help without medication and without any nasty side effects of surgery
Speaker:or medication. The one out of five that we can't help,
Speaker:we educate the shit out of you so you now understand
Speaker:your pelvis and you are essentially prehabbed for
Speaker:success. Welcome to Open Heart
Speaker:Surgery with Boots, where this February we're going
Speaker:below the belt. That's right, we're diving
Speaker:into the surprisingly connected world of heart surgery
Speaker:and pelvic floor health in this five part series
Speaker:series. Join me and our special guest expert, Dr.
Speaker:Kelly Sudakis as we talk about everything you're too
Speaker:embarrassed to ask your cardiologist. From what makes a
Speaker:happy pelvis to getting your groove back after
Speaker:surgery, to yes, even the great post
Speaker:op poop debate. With candid
Speaker:conversations, practical advice and plenty of laughs,
Speaker:we're exploring the ups and downs of recovery.
Speaker:Because let's face it, healing happens from top
Speaker:to bottom. So buckle up for some real talk about the
Speaker:parsif recovery nobody warned you about.
Speaker:Hello, welcome to Heart Month on Open
Speaker:Heart Surgery with Boots. I am your host, Boots Knighton.
Speaker:Please give a gigantic welcome to
Speaker:Dr. Kelly Sudakis who is coming at you
Speaker:today from Drake's Idaho. I am down in Victor,
Speaker:Idaho and Kelly and I have
Speaker:known each other for quite some time and both of our
Speaker:lives have taken all kinds of interesting and winding paths.
Speaker:And here we are today and for the month of February
Speaker:to bring you a whole series on the
Speaker:pelvis and
Speaker:and I cannot be more excited. And this is coming
Speaker:on the heels of my four year anniversary of
Speaker:open heart surgery. Oh my gosh, I can't believe that
Speaker:Boots. And I
Speaker:am just astonished that just now
Speaker:at four years, I am finally learning about
Speaker:what it means to have a pelvis, to take care of the
Speaker:pelvis, what is a healthy pelvis? Because
Speaker:lo and behold, thanks to you, I just recently
Speaker:learned that open heart surgery affects the
Speaker:pelvis and pelvic health. I wanted to bring you
Speaker:on for the whole month of February for Love month
Speaker:and Heart Month. Love Month. What is
Speaker:more love than the heart and the pelvis, right?
Speaker:Like the two primary pieces in Love month. So
Speaker:thank you so much for having me boot. So a little more
Speaker:about me, guys. I am a pelvic health physical
Speaker:therapist. I have been in pelvic health my entire
Speaker:Career, which is about 25 years now.
Speaker:And I feel so blessed.
Speaker:And in this calling, I really do consider it a calling to
Speaker:reach people and helping people understand their
Speaker:pelvis and their pelvic health, and helping them pee better and
Speaker:poop better and have more fun in the bedroom. When you
Speaker:can help someone with those things, you help them on a such a
Speaker:deeper, more holistic level than just helping them with their shoulder
Speaker:pain. So it's been such a personally fulfilling
Speaker:journey. As with many other pelvic health
Speaker:pts. Probably about 10 years into my career,
Speaker:I was feeling a little overwhelmed and burned out
Speaker:with patient load and having a huge wait
Speaker:list and dealing with the insurance game. And so many people needed my
Speaker:help. And I often had a wait list of two to
Speaker:three months for people to come in to get help from me. And we'd
Speaker:often help them in just one or two visits. So I began to think,
Speaker:how. What can I do to reach more people? And
Speaker:through a circuitous, amazing
Speaker:journey. In 2020, I launched
Speaker:Pelvic Floor with the vision to change the
Speaker:world one pelvis at a time, starting with you
Speaker:and how we're going to do that. The mission is to reduce
Speaker:geographic financial psychosocial
Speaker:barriers to accessing this information about pelvic
Speaker:health. And boots, four years into your journey, you're
Speaker:just learning about this. I meet physicians that are
Speaker:50 years into their successful medical practices that have never
Speaker:understood the relationship of pelvic health to
Speaker:the whole body, you know, and so you are actually ahead of the
Speaker:game for most. And I am so grateful that your listeners here are going to
Speaker:get to learn about the pelvic floor and the heart
Speaker:here in February, heart month. Oh,
Speaker:today, though, like, before we get into all those deets, this is like, you
Speaker:know, pelvic floor 101. Like, what the heck is a
Speaker:pelvic floor? Right, right, right. Yeah. What
Speaker:is it? And so, listeners, I've asked
Speaker:Kelly to just treat us like we are
Speaker:starting from scratch and treating me like I
Speaker:have just shown up in her office for the first time and we're going
Speaker:to take it from there. So this is like, we're not skipping over
Speaker:anything. I have not seen Kelly for my pelvic floor, although
Speaker:I do need to. And call me. I'm just going to be
Speaker:overt about that. And that is okay. Like, this is going to be a
Speaker:series of it's okay to talk about weird and
Speaker:awkward things. It doesn't have to be weird and awkward, but
Speaker:if we're thinking about one of the impetus of me starting this
Speaker:podcast was. I didn't learn. I didn't get
Speaker:instructions on how to heal completely from open heart
Speaker:surgery. It was only focused on the heart and the
Speaker:chest. And it didn't include the emotional, spiritual aspects. And it
Speaker:definitely didn't include the pelvic floor. It didn't include
Speaker:nutrition, which is why I had the whole series in October of
Speaker:2024 with Michelle. And so the whole point
Speaker:of this podcast is to help you find healing mind,
Speaker:body, spirit, head to toe, front to back.
Speaker:Amen, sister. So we're starting from scratch.
Speaker:I'm starting with you listeners, so. All right, Kelly, I just
Speaker:love it. Your office. I love it. Okay, let's dive
Speaker:in. So if you were seeing me or another pelvic health physio
Speaker:in person, we would do a detailed medical history about
Speaker:everything that's gone through, everything you've gone through in your life, right? What
Speaker:surgeries have you had, et cetera. We would
Speaker:dive into, if you have a vagina, into your menstrual history
Speaker:as well. When did your periods start? How regular were they? Were
Speaker:they painful? We then are going to ask
Speaker:questions about pee, poop, and intimate
Speaker:functions, regardless of what type of pelvis you have.
Speaker:And based upon those
Speaker:answers, then that guides the
Speaker:rest of the visit. So, Boots, you and your listeners, we're going to
Speaker:just go through, number one, what's normal, and then we're going to
Speaker:talk about the anatomy and, like, how of the bones
Speaker:and the muscles and how they work to provide
Speaker:that quote unquote normal function. And then
Speaker:we'll get to the nitty gritty of what's not normal.
Speaker:And, you know, what's not normal might be ludicrously common
Speaker:in this world of pelvic health, but that doesn't mean
Speaker:that we have to deal with it. Right? The, the incidence of pelvic problems.
Speaker:So pelvic pain, problems with peeing and pooing, it is the same
Speaker:incidence as back pain in the world. Eight out of 10 people
Speaker:will suffer from some type of pelvic problem in their
Speaker:lifetime. But here's the thing. When you have back
Speaker:pain, the average time that it takes you to get care
Speaker:is two to three weeks if it doesn't resolve. If you have a
Speaker:pelvic problem, pain, pee, urgency, pee
Speaker:leaks, poop problems of constipation or loose poops, sexual
Speaker:problems. Your average time before you seek
Speaker:care is five to seven years. And I would
Speaker:honestly argue that that's five to seven years for someone with a
Speaker:vagina. And someone with a penis might even go longer than
Speaker:that for a multitude of reason. Reasons. And it's because
Speaker:we think it's a normal consequence of aging. It's because we're ashamed and we
Speaker:feel alone. And then worst of all, if we go to ask
Speaker:for help and we're told by a medical provider that it is normal
Speaker:and it just stops our ability to progress, which is so sad. So I'm
Speaker:so grateful to be here to talk to you about these things. To number one,
Speaker:improve awareness. Number two, encourage you to get your cute butts in
Speaker:for help. And then, number three, we might even save some
Speaker:lives by learning about a few pelvic changes that are shown
Speaker:to pre. I exist before
Speaker:heart issues. Oh, my gosh. Are we
Speaker:ready? I am so excited. I feel like I
Speaker:need to get, like, school supplies ready. And like.
Speaker:Yeah, and we're going to be saying
Speaker:penis and vagina and sex, like all the.
Speaker:I mean, it's all the words that go with the pelvis. And I hope
Speaker:you are listening to this and you're already, like, feeling
Speaker:squeamish. I invite you to sit with the discomfort
Speaker:because what I really want for you is complete and total
Speaker:health. And that includes your pelvis, and it includes your
Speaker:vagina and your penis. Can I say that? Yes. Yes, girl. And we.
Speaker:We should do a whole nother talk about, I think the Latin origin of
Speaker:the perineum is like that. That shall not be named
Speaker:or something. Oh, my gosh. So then there's a whole nother talk about, like, purity,
Speaker:culture and stuff. But we'll. That. That's for later. So first and foremost,
Speaker:folks, what is normal in the pelvic floor? Because
Speaker:to understand what's not normal, we need to start with the basic ground rules of
Speaker:what is normal. Regardless of your age,
Speaker:regardless of what parts you have in your pelvis,
Speaker:we ought to pee on average once every
Speaker:three to four hours while awake. And when we
Speaker:pee, it should be preceded by a
Speaker:gradual urge to pee, never a freight train.
Speaker:Hey, get your butt to the bathroom right now. No, no, no. It should
Speaker:start as a whisper that gradually builds up that we
Speaker:eventually listen to on our own terms when we
Speaker:start the stream, it should be very easy to start the stream.
Speaker:To maintain the stream of pee, that stream should last
Speaker:at least 10 to 15 seconds of a nice healthy stream. Per
Speaker:pee following the stream, we should either give it a
Speaker:wiggle or a single wipe and be able
Speaker:to stand up if we're already standing, tuck things in, have
Speaker:no post void dribbles, and then the cycle
Speaker:resets. There should never be any Pee
Speaker:leaks. There should never be any leaks associated with
Speaker:urgency. Jumping, laughing, coughing, sneezing. That
Speaker:should really never happen. Hmm. When we
Speaker:finish peeing, we should feel satisfied. We should not feel like it burns
Speaker:when we pee or that it burns afterwards.
Speaker:In general, we should actually sleep through the night without awaking,
Speaker:awakening to pee. And this is something that is considered
Speaker:normal as we age, or doctors will even say it's normal during pregnancy to get
Speaker:up at night to pee. And I would beg to differ. Like maybe we'll give
Speaker:you one pee a night by like your third
Speaker:trimester because then baby actually is settling down,
Speaker:possibly in the first trimester because of the increased blood
Speaker:flow. But in general, I want you sleeping. The
Speaker:importance of sleep for overall holistic health cannot be
Speaker:overestimated. And I want you to sleep whilst still
Speaker:being hydrated. So yes, there are a few caveats within
Speaker:this and I don't want you to dehydrate yourself
Speaker:at all because hydration is important. So if I go through my whole day and
Speaker:I haven't drunk enough water and I drink 32 ounces right before bed,
Speaker:bed, in that particular case, I might need to pee at
Speaker:night and it's better to be hydrated and wake up once and pee.
Speaker:But if I'm only drinking 30 ounces during a
Speaker:whole day, like that is woefully inadequate. I should not,
Speaker:and I should not be waking up to pee that night. But I might be
Speaker:because I might be dehydrating my bladder, but I'm getting ahead of myself a
Speaker:little bit. And so all of that P function
Speaker:should occur with us drinking this normal
Speaker:amount of water which we take our body weight in pounds and we
Speaker:divide it by two. So I weigh 160 pounds, so
Speaker:I should be drinking at a base level 80 fluid ounces
Speaker:every single day. 75% of that should be non
Speaker:caffeinated, non alcoholic. Really. Alcohol
Speaker:is just a chemical shitstorm. Like we should all be avoiding it at all
Speaker:costs. And then if I am living in a high,
Speaker:dry mountain climate, if I'm exercising, that base amount
Speaker:needs to go up a little bit. So am I
Speaker:having all those normal P functions while being adequately, hi
Speaker:adequately hydrated? That's a really important thing to
Speaker:check. Poop. The same muscles that
Speaker:control the P function also control poop function. So what's normal for
Speaker:poop? Poop has a little bit wider range. We
Speaker:should poop anywhere from three times a week
Speaker:to three times a day. And it needs to
Speaker:be soft formed and non emergent.
Speaker:As long as it's soft Formed and non emergent. We
Speaker:sit down, we hopefully elevate our feet
Speaker:up on a little stool, we relax our pelvic floor and
Speaker:our colon pushes the poop, poop out. In
Speaker:heart health, specifically Boots, this is a big deal.
Speaker:If we strain to push poop out, we could
Speaker:bring on a cardiac event. Not okay.
Speaker:But in general health, it's just your bladder pushes your
Speaker:pee out, your colon pushes your poop out. And if you have a
Speaker:uterus and you're pregnant, your uterus pushes your vagina out or your vagina.
Speaker:Oops. That was an oopsie. Your uterus pushes your baby out. And
Speaker:if we're straining, then we actually can push other
Speaker:stuff out that's not meant to come out like a hemorrhoid. We could cause a
Speaker:bladder prolapse, we could cause some pee incontinence if
Speaker:we're always constipated and pushing poop out. So that's
Speaker:important. When you poop, are you able to sit down
Speaker:and relax and have that poop happen? Like I'm in under one minute,
Speaker:honestly, in general, and then it's
Speaker:one or two wipes and we should be gone. We should be done. Like it
Speaker:should not take half the roll of toilet paper to clean
Speaker:up. And if it does, that's something that's called smearing and that's again
Speaker:abnormal, something we can work on. And I have to
Speaker:object that I do know someone know
Speaker:of someone who died of a cardiac event on the
Speaker:toilet at work. It was so sad.
Speaker:Right, right. And we'll talk about that like, and like, yeah, if
Speaker:we don't talk about it today, we're going to talk about it in one of
Speaker:these segments. But like it's a big deal and it's something that we need to
Speaker:talk about first and foremost from a primary health perspective. But
Speaker:secondly, your listeners, this is open heart surgery with Boots.
Speaker:So people that are here, we have a vested interest in managing this
Speaker:arterial pressure. So if you've been a terrible pooper your whole
Speaker:life, guess what, it's time to change. And it can get better.
Speaker:And especially in the post surgical phases with
Speaker:the medicines. Oh my gosh. Like, we really need
Speaker:to understand what goes into poop. The whole
Speaker:poop section. Again, there's so much we can do
Speaker:nutritionally and hydrationally and musculoskeletally
Speaker:to set you up for poop success. And the
Speaker:greatest thing about all this is it's going to be overwhelming for some of you
Speaker:listeners and just please don't be overwhelmed. You have access to this you can watch
Speaker:this a zillion times. Take notes. You'll absorb what
Speaker:you're ready to absorb. The same
Speaker:specific and simple things that will help improve the pee
Speaker:function, will improve the poop function, will improve the bedroom
Speaker:function. So please just be kind and curious and not
Speaker:overwhelmed with all this, because this is a lot of stuff that we're going to
Speaker:cover in 30 minutes. Okay?
Speaker:Sexy time. The bedroom is for two things.
Speaker:Sleep and something else, my friends. And
Speaker:something else. The intimacy. It should be pain
Speaker:free, unless you want it to hurt,
Speaker:but that's a whole different talk. But
Speaker:intimacy should be pain free at the start.
Speaker:You should be able to experience a pleasurable
Speaker:rise to a climax, which should also be enjoyable and
Speaker:pain free. And we should have no pain
Speaker:afterwards. There should be no leaking of pee
Speaker:or poop during intimate functions. And we
Speaker:should not regularly have urinary tract
Speaker:infections following. You know, there are some basic
Speaker:things that, you know, with hygiene are good to follow.
Speaker:But if you're always getting a UTI every time after you're intimate,
Speaker:there's probably something else going on. And we're going to talk about
Speaker:that in a moment. Oh, and you know, if you
Speaker:are still menstruating, if you have a vagina and you're menstruating,
Speaker:this is going to blow your mind. Period should be pain free.
Speaker:What? Complete. Yeah, the.
Speaker:Yeah, think. I'm just thinking about how
Speaker:it is just. I'm just thinking about all my years. Like
Speaker:I've been. Hold on, I just need a second. I know, right? I
Speaker:know. Me too. I. So I am a double board certified doctor of
Speaker:physical therapy, one of like 100 doctors of physical therapy in the world,
Speaker:double board certified in pelvic health and orthopedics. I just
Speaker:learned this less than 10 years ago, that periods are supposed to be
Speaker:pain free. And I didn't even believe it when I think maybe even five
Speaker:years ago, because my boobs have hurt my whole life
Speaker:until I learned this. My labias, that's like the part you can see on
Speaker:the side of the vag. Like, those would always be very sore. The second day
Speaker:of my cycle made a few specific changes.
Speaker:And pain free. It's insane. And we
Speaker:don't know this. We normalize pain for women and it's not
Speaker:okay. And when we can do things to control the
Speaker:pain, which again, are a lot of the same things that I'm gonna talk to
Speaker:you about, we can make your periods pain free. And if we
Speaker:can't, and especially if they're debilitating, that can Be a
Speaker:sign of a condition called endometriosis, which is something totally
Speaker:separate. And you need to get your cute butt in for appropriate
Speaker:treatment. There's a study of women, younger
Speaker:girls, who ever missed school or work due to
Speaker:period pain. Almost 100% of them have this condition called
Speaker:endometriosis, which, which is super debilitating. And we are like, oh,
Speaker:it's just period pain. And we, we just shove them. Oh, just take this
Speaker:medicine. It's like, no, listen to them. This is a huge deal.
Speaker:Well, and I was thinking about all the marketing from like the
Speaker:ibuprofen, Aleve, Motrin, and.
Speaker:And it just seems like it's just accepted. And that's just how it is. And
Speaker:so you just have to take this and then that will make your periods better,
Speaker:you know, and just how. I think I've had my period for maybe 30
Speaker:years now. And I just assumed that that was just part of
Speaker:being a woman. That's so infuriating. I know, right? Isn't it?
Speaker:Isn't it? So we can. We'll talk about the things that we can do to
Speaker:change that. So that is the basics of, like, what's normal.
Speaker:Now, if you were coming to see me one on one, we would touch very
Speaker:lightly on each of those. I would have on your intake,
Speaker:though, your chief complaint, your reason for seeing me. So I might spend a
Speaker:little bit more time on one of those items than the
Speaker:other. We would then go into educating to the muscles
Speaker:of the pelvis and the core and explaining how those
Speaker:things happen. So we would begin with the bladder because
Speaker:pee urges and pee leaks are one of the primary reasons that someone might come
Speaker:to a pelvic floor. Physical therapist and your bladder. And
Speaker:for those of you who can see this on video, we have your cute
Speaker:little bladder here that kind of rests upon
Speaker:a shelf that is the pelvic floor.
Speaker:And that shelf, I'm going to hold up Patty, the pelvis here,
Speaker:who is an anatomical model of the pelvis.
Speaker:And essentially, white parts are bones, red parts in
Speaker:general are muscles. And we have the bony
Speaker:pelvis is like the structure of the house, the
Speaker:drywall. You've got your low back in the very back,
Speaker:and then you have a ring of pelvic bones that are made
Speaker:of your two hip bones and your sacrum behind that
Speaker:kind of form, this circle, right? That's base of your core.
Speaker:You have tummy muscles that help dynamically
Speaker:support this pelvis in the front and kind of connect the two
Speaker:pelvic bones. You have butt muscles that go from the back
Speaker:of your hip bones to your leg bones and back.
Speaker:And, and from my humble perspective, most
Speaker:importantly, you have this incredible hammock of
Speaker:pelvic floor muscles that form the bottom of this
Speaker:bowl. And those of you that can see, I know, right,
Speaker:they go from the front of your sacrum all the
Speaker:way to the back of your pubic bone. That is
Speaker:quite right. And get this girl and
Speaker:boys, everyone who's looking and watching, it's not just one
Speaker:muscle on the bottom, it's a whole
Speaker:group. And I highly recommend if you can check out the video
Speaker:to do so at this exact minute, it's more than
Speaker:13 muscles on the right and the left. Just like
Speaker:you have right legs and left legs and this one here is a
Speaker:vad. You can see the two holes, but penises are not that different
Speaker:really. It's just this top hole is kind of closed. But they're mostly all the
Speaker:same muscles internally, they all have different
Speaker:roles. Constricting the urethra, the P
Speaker:zone, elevating the middle of the perineum, which is that
Speaker:muscular middle support controlling the rectum and back, helping you keep your
Speaker:balance, right? And like what, it's
Speaker:amazing that they ever work in the first place. And
Speaker:truly. So you've got this cute little bladder resting
Speaker:on that hammock and, and in real life,
Speaker:this is the. And already right now, you listeners, you
Speaker:boots know more about your pelvic floor muscular
Speaker:anatomy than probably most primary care
Speaker:providers. Just from this last three minutes, just. From that
Speaker:last three minutes. Because most primary care providers in medical school
Speaker:got one lesson on the pelvic floor that was taught by possibly a
Speaker:pelvic floor physio, possibly just a physiological. And
Speaker:then they went on to, quote, unquote, more important things,
Speaker:right? They went on to medicines to help save lives, to
Speaker:surgeries to help save lives. So this is not to minimize or say that they're
Speaker:missing something, but they just had to go down a different road and they
Speaker:never got this education. And now you
Speaker:are though, and so you can be your own advocate. All
Speaker:right, so we've got this cute little bladder resting
Speaker:upon that hammock of pelvic muscles.
Speaker:And the pelvic muscles are like an elevator in
Speaker:a four story building. And they're
Speaker:meant when they're super happy and healthy to rest on the ground
Speaker:floor of this four story building. And then
Speaker:with day to day life, the brain should automatically
Speaker:decide how much muscles to use when you stand
Speaker:and walk and run and pick up your groceries. And it should decide to
Speaker:bring the Muscles up to that second, third, fourth floor and
Speaker:back down again. When we sit down to pee or
Speaker:poo, it should know how to relax them into the sub
Speaker:basement and then come back to that ground
Speaker:floor again. They're kind of like always on standby.
Speaker:Pelvic problems, including leakage,
Speaker:they primarily occur not because the pelvic floor is
Speaker:sloppy and loose and open,
Speaker:but because, for a variety of reasons, it starts to
Speaker:rest too tight.
Speaker:There's your second big mind blowing thing of the
Speaker:day. Because for most humans, when you start to have
Speaker:any type of pelvic problem, we are going to
Speaker:do Kegels, and that's totally the wrong thing to do. Kegels
Speaker:are the least important part of the pelvic perspective, and they will
Speaker:typically make PE leaks, make pain, make sex
Speaker:worse. Whoa. When I hear
Speaker:that, that's like the main treatment for everything. And
Speaker:who told you that? Yeah, I mean,
Speaker:I. You just. You just know. Yeah, you
Speaker:just. Isn't that funny? You just know. But here's the dirty
Speaker:truth about Kegels. People were just told to do
Speaker:Kegels because, oh, if you're leaking, yes, clearly the
Speaker:pelvic floor must be weak. So you should tighten them in the 80s.
Speaker:So this is the 80s. There's not even cell phones yet. All phones are still
Speaker:connected to the walls. Right. There was a landmark study by
Speaker:Bump et al that told people
Speaker:to do Kegels. Then they followed up and they found
Speaker:that just telling someone to do Kegels, if you had 100
Speaker:people, by sheer luck, 1/4,
Speaker:25 of those people would get better. However,
Speaker:the same amount, 25%, would actually get worse and
Speaker:half of the people would not see any change. And
Speaker:that's because there was no actual education
Speaker:connection to the muscles. So let's bring it back
Speaker:to our elevator analogy, right? The
Speaker:way the body reacts to pain,
Speaker:dysfunction, and stress. And boots
Speaker:your comment in the opener. In your open
Speaker:heart surgery journey, you were not treated holistically. You did not
Speaker:receive this education into what happened. Beyond the physical
Speaker:heart. The pelvic floor has a direct connection
Speaker:to your amygdala, which is your emotional center of
Speaker:your brain. If we show a college age woman with
Speaker:no history of abuse or stress.
Speaker:Stress beyond life. A picture of a dark
Speaker:parking lot. Her pelvic floor will clench because it senses the
Speaker:potential for danger. Whoa. This is a survivalistic
Speaker:standpoint. If we are physically stressed, emotionally
Speaker:stressed, the amygdala tightens. The pelvic floor brings
Speaker:this elevator up to the second or the third floor as a
Speaker:sympathetic fight or flight response to help us get ready to run away from this
Speaker:tiger. Right? And now like, what is.
Speaker:And heart surgery is stressful, My Lantai. It's
Speaker:stressful, right? Life is stressful.
Speaker:That's going to start to bring this up to the second floor. And it's something
Speaker:that happens that we're not cognizantly aware of. Right? So, so we
Speaker:don't. If I say, relax your pelvic floor, you think it's already relaxed.
Speaker:So now I'm resting on the second floor here. My pelvic floor is doing too
Speaker:much work all the time. That's going to irritate my
Speaker:urethra, that's going to maybe annoy my bladder, so it
Speaker:starts to send a more urgent signal. And depending on
Speaker:everything else that's happening upstream, that
Speaker:now that these muscles are doing too much work all the time, they might not
Speaker:have energy to hold my pee in when I need to
Speaker:and I might start to pee my pants. And now we
Speaker:have this like net downward spiral. Now that's stressful.
Speaker:I might, because I quote unquote know that I'm supposed
Speaker:to do Kegels, I might try to tighten up more. And now,
Speaker:now I'm resting on the fourth floor and lo and behold, my urges and my
Speaker:pee leaks get worse because the problem's not that my muscles are
Speaker:so loosey goosey that I'm. I've been in a wall sit for
Speaker:18 years and now I'm asking myself to go run a
Speaker:marathon. Like, it's so sad.
Speaker:Well, and I hate wall sits.
Speaker:And I have. And I have really silly Instagrams. I'll get you the links
Speaker:that we could put under about how these tight muscles can cause
Speaker:leaks, but they also cause pelvic pain
Speaker:with intimacy because they close the door. Essentially, they cause
Speaker:us be to be unable to climax because the muscles that are
Speaker:associated with climax are high performance muscles. So if they're
Speaker:not healthy, we're not going to be able to build into a climax. We're not
Speaker:going to have one. If we have a penis, we might not be able to
Speaker:have an erection. And that's a huge deal that we're going to talk about in
Speaker:the next segment. It's an independent risk factor for major
Speaker:adverse cardiac event, period wise. Guess what? Are you
Speaker:ready for your third mind blowing topic? Okay.
Speaker:It's been mind blowing for 30 minutes already. Like, oh no, it's already 30 minutes.
Speaker:What? We might have to divide it into two. Not just saying all of this
Speaker:has been mind blowing. So. But we need this Is why we need to talk
Speaker:about it, because there's so much. Right. So here's these sweet pelvic muscles
Speaker:again. For those of you that can see, I just showing the. The. The in.
Speaker:I'm inside the belly, looking down. There's all these different pelvic muscles. Here's a
Speaker:vag. Guess where these muscles. I'm pointing to the muscles kind
Speaker:of on. I. Oops. That was the rectum. I'm. Trust me, I'm a doctor. Here's
Speaker:the vag. These little muscles on either
Speaker:side of the pelvic floor. You know,
Speaker:if you have a heart attack, where do you feel the
Speaker:pain? By common knowledge, boots, Is it in your heart or
Speaker:is it. Could it be elsewhere? Well, the two I've had,
Speaker:yes. My left arm, the first one. My left arm, my
Speaker:chest. But the second one here was. Here's the crazy
Speaker:part. The second one, I had no pain, but I had
Speaker:stopped peeing. No. Oh, my gosh. Okay. That's wild. I
Speaker:can't wait to dive in. So first one, had we worked on your
Speaker:arm, it not only would not have helped, but you might have
Speaker:died. Right? Like. Like not understanding where the pain was
Speaker:coming from. These pelvic floor muscles that live on
Speaker:either side of the vagina and then even further back towards the rectum, their
Speaker:referred pain pattern, they don't tip it. They could hurt in the vulva.
Speaker:Sometimes they could hurt in the pelvic floor. They're more common.
Speaker:Referred pain pattern is the lower abdomen.
Speaker:So that's where your period cramps can come from.
Speaker:In the absence of endometriosis, the pelvic floor resting too tight.
Speaker:During the period process, there's increased inflammatory chemicals.
Speaker:Everything's resting just below the pain threshold. Here comes the period. Here comes the
Speaker:chemicals. Boom. We cross the pain threshold, and we can put a hot
Speaker:pack on our lower bellies as much as we want. And it might help a
Speaker:touch, but we actually need to do is relax. The pelvic floor,
Speaker:dude. Wild, right? I know, I know. And then the third
Speaker:hole moving backwards, you know, is the rectum back there. So we have
Speaker:that sweet rectum. Where. Where's my rectum gone
Speaker:to? There it is. Found
Speaker:it. Does it have a name? Because we've got Patty Pelvis.
Speaker:Patty the rectum does. I have Patty the pelvis. And it. It
Speaker:alternates between Peter the pelvis and Philip the pelvis. The rectum
Speaker:doesn't have a name, though. I should name it Randy. Randy the
Speaker:rectum. I.
Speaker:All my friends named Randy out there. Just going to Tell them that I just
Speaker:named my rectum Randy. Yeah, yeah, you heard it. You heard it here
Speaker:first, people on open heart surgery. Boots. Yes,
Speaker:Randy. Yes. Ran random Randy. The rectum has been named
Speaker:and I like it. We're keeping it. So you got the rectum back
Speaker:here. And remember that hammock of pelvic muscles, right?
Speaker:Same thing happens back here. It's meant to rest on that
Speaker:ground floor, come up to support our pelvic pressure during
Speaker:life, relax to give the on switch
Speaker:to the colon to push the poop out when
Speaker:that pelvic floor starts to elevate in response to
Speaker:life stresses, in response to physical pain, in response to,
Speaker:oh, gosh, I'm having pee problems.
Speaker:Now we not only have the problem that it's much
Speaker:harder to relax and open the door to give the on switch for the
Speaker:colon to push the poop out, we're also engaging a
Speaker:backwards reflex called the rectal anal inhibitory reflex.
Speaker:We'll talk about this in the poop one. But we're engaging a reflex
Speaker:that the brain thinks we're running away from a tiger and we don't have time
Speaker:to stop and poop. So the brain's going to push the poop back up the
Speaker:tube to give us a little bit of time to escape the tiger.
Speaker:But that's meant to be like a very short term solution. So
Speaker:what if we're resting up on that second or that third floor for days, weeks,
Speaker:months, years on end, our poop is always getting this
Speaker:negative signal. And so that's going to elicit,
Speaker:typically more of a constipated trend. So the
Speaker:poop's going to be harder to come through. It's going to be harder for us
Speaker:to relax and give the signal for the colon to push out.
Speaker:And then if we're straining to force the poop
Speaker:out now there's all the other problems, the collateral damage, so
Speaker:to speak, for the heart system and for the pee and the vag, if
Speaker:we have one. Right. So the key in all of
Speaker:this is to, number one, understand that because before
Speaker:these last 30 minutes boots, have you known any of
Speaker:this? None. And you
Speaker:are a very educated woman and you are in
Speaker:this heart surgery world and you're an active human. And
Speaker:like you, you've had a period your whole life. So isn't it just mind blowing
Speaker:that we don't know this? Well, I mean, I think how
Speaker:unfair it is. It just leads to so many
Speaker:unnecessary mind, body, spirit
Speaker:issues that could be so
Speaker:avoided. And, you know, just, just to like, talk about how I'm
Speaker:educated. My undergraduate degree is in biology.
Speaker:My graduate degree is in education. I
Speaker:taught high school science, so it's not.
Speaker:And I also taught at the collegiate level. I'm naturally
Speaker:curious. I'm almost 47 years old and I
Speaker:am just now learning this. So I just want to lay
Speaker:the groundwork of really, what the
Speaker:fuck? Exactly, exactly. And you
Speaker:think about what happens. So we look at all these studies about
Speaker:that gap in care that like, for most people, they're going to wait at
Speaker:least five to seven years before they talk to a physician about their
Speaker:pee problems specifically. And then depending on that
Speaker:physician's education, like, what are they going to do?
Speaker:Like now, if that person isn't watching this podcast, if they're not
Speaker:following me on social media, what if that physician's like, oh,
Speaker:here's a pill that's going to like, let's
Speaker:say it's pee urgency, that's going to calm down your bladder. Does that
Speaker:fix any of this musculoskeletal stuff? It doesn't.
Speaker:And it's not without risk. There is the same things that that pill
Speaker:works on to relax your bladder. It interferes with your cognitive
Speaker:function. And people don't know that. There's not like, informed consent. A
Speaker:poop problem, Right. If the doctor knows about pelvic
Speaker:PT, which again, there's. Our success rate is 80%.
Speaker:So we can help four out of five people that come into our door with
Speaker:pee problems, prolapse problems, sexy time problems, poop problems. We can
Speaker:help without medication and without any nasty side effects of surgery
Speaker:or medication. The one out of five that we can't help, we
Speaker:educate the shit out of you so you now understand your
Speaker:pelvis and you are essentially prehabbed for
Speaker:success for whatever that next step might be. And we can help
Speaker:guide you to, hey, based on our experience, this should be
Speaker:the next step because surgeries are not always bad. Open heart surgery
Speaker:saved your life, prolapse surgery, bladder surgery, sometimes you need a
Speaker:colon surgery. They're all amazing in the right place. But
Speaker:just like you would never have a knee surgery like
Speaker:an acl and then be like, oh, well, just rest six months, you'll
Speaker:be fine. Like, you'd maybe survive, but you would not
Speaker:thrive. You should never have a pelvic procedure.
Speaker:Ideally, we'd always have prehab. But you should never have a pelvic procedure
Speaker:without post operative pelvic floor physical
Speaker:therapy. And that includes appendectomies,
Speaker:gallbladder surgeries. That includes open heart surgery. I know it's not a
Speaker:pelvic surgery, but it's a whole body surgery, and so that
Speaker:should be a part. And it's not yet a standard of care. But
Speaker:we just talked about what happens to the pelvic floor in response to
Speaker:stress. Right. There's not much more stressful than open heart
Speaker:surgery. I just wanted to interject in that because. And I'm going
Speaker:to get real personal here for a second. Yeah, yeah.
Speaker:I'm thinking post op for me. And if you, if you're
Speaker:just now finding this podcast, first of all, I'm tickled you're here. You're here.
Speaker:Thank you so much. And I hope that you will
Speaker:subscribe and you'll visit our Patreon and you'll go back and
Speaker:listen, because I've been building a whole network of
Speaker:resources for you heart patients and
Speaker:caregivers for, for thriving post surgery.
Speaker:But I, I bring that up because I want you to go back and listen
Speaker:to my story in episodes one and two. And I
Speaker:definitely talk about the first few days of just
Speaker:how my body needed to purge. And one thing I wanted to bring up,
Speaker:you know, I. I threw up 25 times post
Speaker:sternotomy, which was just hell on earth. But
Speaker:then I obviously couldn't poop. And one
Speaker:question I have for you, Kelly, is, you know, you hear about
Speaker:post surgery, you can't poop. And granted, I had the
Speaker:P tube in for a few days getting the fluid out of me, and that
Speaker:was fine once it came out, but I couldn't poop and
Speaker:I needed to poop. I knew I needed to poop. And so then I drank
Speaker:a diuretic. But then I made it.
Speaker:I. Then I couldn't control it. And so I just like to
Speaker:say I took advantage of all the CNAS on the floor.
Speaker:That's why they're there.
Speaker:Exactly. But it was like such an
Speaker:intense experience. And if we, you know, in these last few
Speaker:minutes of this first installment talk about that,
Speaker:because, yes, it is so important to poop post
Speaker:surgery because I. I have two
Speaker:pages, single spaced, font size
Speaker:10 list of all the medications that were put into my body
Speaker:during open heart surgery that needed to come out.
Speaker:Right, Exactly. No, this is such an important part of
Speaker:the discussion Boots. And we should do, you know, we'll do like a whole thing
Speaker:just about pooping, but in general, the key things that
Speaker:you can do, there is a very simple,
Speaker:easy belly massage that we could start. And we
Speaker:honestly should start these things that I'm about to say we should start them
Speaker:pre open heart surgery as well, because they are all going to be things to
Speaker:help connect to this pelvic floor and calm it back
Speaker:down. The one additional part that also contributes to that tight
Speaker:pelvic floor, beyond the physical stress and the emotional stress of the
Speaker:surgery. Breathing, Right. How after a
Speaker:sternotomy, how was it to breathe?
Speaker:Suzanne, you had respiratory therapy, right? Like so.
Speaker:Yeah. Breathing's hard and we're not going to get into too
Speaker:much except to blow your mind. A fourth, possibly final time of
Speaker:this talk. The pelvic floor muscles are an accessory
Speaker:muscle of breathing, which means that in their. Yes,
Speaker:that in their perfect state, when we are relaxed and those cute
Speaker:little pelvic floor muscles are down here, I got Randy the rectum. When they're
Speaker:down here on the ground floor, we're totally relaxed. You breathe
Speaker:into your belly and your belly gets bigger and you exhale and
Speaker:your belly gets smaller. Diaphragmatic breathing core of every
Speaker:post open heart surgery, do they ever once say,
Speaker:hey, tune into your pelvic floor as you inhale
Speaker:and your belly gets bigger. Your sweet little pelvic floor is up here on the
Speaker:third floor. Can we inhale? Belly gets bigger. Pelvic
Speaker:floor drops towards the ground floor. Can you exhale?
Speaker:Belly gets smaller. Pelvic floor stays
Speaker:relaxed. That was never mentioned.
Speaker:Of course it was never mentioned. And we are, pelvic pts are making great
Speaker:strides in OB floors, finally coming in to
Speaker:see women post baby, post cesarean. Hugely important. It
Speaker:is just as important for us to start to have a presence on open heart
Speaker:surgery floors and in the ICU or even collaborating with your
Speaker:respiratory therapist. But that singular piece of
Speaker:belly breathing, step one, again, pre heart surgery, we
Speaker:are super stressed, right? If we are able to, if it's
Speaker:not this emergency thing, we know this is coming. We're very stressed. Our pelvic floor
Speaker:is going to be up here. So we owe it to ourself to do some
Speaker:of that diaphragmatic breathing to stimulate your
Speaker:parasympathetic nervous system, the calm the rest and digest
Speaker:system to bring the pelvic floor specifically down
Speaker:to not irritate the bladder or Randy the rectum
Speaker:here. Now, so that's one thing is this belly breathing we can do and
Speaker:we can start that as soon as we are out of
Speaker:surgery. The second thing is a very simple belly
Speaker:massage. And what will physically happen is at first you're going to
Speaker:say, well, I can feel that belly moving, but I
Speaker:can't feel anything back here. And that's just curious. We're
Speaker:not angry that we can't Feel that. But we're simply curious. And that's going to
Speaker:give our brain permission to try to find those nerves, because I guarantee they're
Speaker:there for you. Um, in a future one, we'll go over the exercises, but just
Speaker:being aware of that and possibly even sitting on a little rolled
Speaker:towel vertically. So a little pressure on the vag or the
Speaker:part behind the scrotum, a little pressure on the rectum. Inhaling, try
Speaker:to encourage those pelvic muscles to come down. Is huge.
Speaker:Secondarily, belly massage. Um, those of you that can see
Speaker:me, I'm going to stand up here. Here's my belly. You would have a
Speaker:big old incision here. We would be laying down. And this is my
Speaker:belly button. This is clockwise. I never
Speaker:know what direction my video shows up. But we
Speaker:would be laying down. Relax. And we would do gentle pressure,
Speaker:gentle circles in a clockwise direction. This
Speaker:is called sunflower massage and old
Speaker:school, I love you massage.
Speaker:Fine. It's better than nothing, but I'm going to give you something better. Old school
Speaker:I love you massage is you would do an I coming up from
Speaker:the right hip here, and then an L up and
Speaker:over and then a U and. And that's
Speaker:fine. And the theory is that you're helping to move the
Speaker:poop through the tubes. I want to be very honest that
Speaker:in real life, you're simply mobilizing the nerves and the blood vessels. But it has
Speaker:an exquisite benefit. Okay, so you would
Speaker:spend three to five minutes of this sunflower massage just
Speaker:feeling your tummy. And it should feel like soft
Speaker:bread dough. And you might get to a spot like right
Speaker:here. Mine's not moving the greatest. Right there. That's
Speaker:interesting. So if I was having any poop
Speaker:issues, that would be good for me to just gently work on. We would never
Speaker:poke into a spot that was sharp pain. If for any
Speaker:reason you had any insertion, like, you know, any
Speaker:ports in here during your surgery, then we wouldn't want to be doing this.
Speaker:But in open heart surgery, we normally don't. But we would
Speaker:do this three to five minutes of this belly massage while belly
Speaker:breathing. Okay. Then we would follow it
Speaker:with the PT version of digestive massage,
Speaker:which is actually going to start at the outhole. So,
Speaker:Randy, the rectum here. I didn't talk about this at first.
Speaker:We just talked about where he was in relation to the pelvic muscles. He's
Speaker:actually turned 90 degrees. So your
Speaker:poop at the end of its journey through the tube has to make two turns,
Speaker:90 degree turns, and that's kind of unfair. That's called your
Speaker:sigmoid colon. But to clear that, you're going to
Speaker:go find your left hip bone, you're going to come to the inside of
Speaker:it. You're going to push in and then pull towards a
Speaker:line between your belly button and your
Speaker:pubic bone. So you're going to push in, pull here, and then release and
Speaker:you're essentially clearing the sigmoid colon.
Speaker:We might be pulling poop into the final holding
Speaker:stage. In reality, you're massaging all the nerves that are going
Speaker:to that colon and helping it move more freely. And
Speaker:you're going to do that three to five times while belly breathing and trying to
Speaker:relax your pelvic floor. And now we've
Speaker:opened the door a little bit of the pelvic floor. We've softened
Speaker:it to take the brakes off the colon. We started to move
Speaker:here. Now we can push here. And this is something that if your arms are
Speaker:tired, if this amount of pressure is sore from the sternotomy,
Speaker:your A partner can help with this. You can use a silicone massage
Speaker:cup three to five times, pushing downwards to
Speaker:help the poop down the descending colon. And again,
Speaker:in reality, just mobilizing all the nerves that are going to the descending
Speaker:colon. We would then do transverse colon. And this
Speaker:depends on how low our incision is. Right. So we're always going to be healthily
Speaker:below the incision. And we could even have a second hand on the bottom of
Speaker:it to make sure we're not disrupting that. And we would go three to five
Speaker:times across. And it doesn't matter that my actual colon is like up here
Speaker:and way back there. This is the nerves that are going to the
Speaker:colon that we're working on, people. Then second to last is
Speaker:ascending colon. I start at the lower right and I pull up
Speaker:and the whole time I'm just any place where I've just created space. Now I'm
Speaker:encouraging poop to move towards or I'm encouraging the
Speaker:nerves to be healthier. Final one is your cecum, where
Speaker:your small intestine meets your large intestine. And it's the mirror
Speaker:of our first one. We push to the right and pull over
Speaker:three to five times, Doing that
Speaker:relaxed breath frequently throughout the
Speaker:day. Doing that colon massage two or three times a
Speaker:day. And then when you move, exhale
Speaker:with exertion. Exhale as you log roll to the side.
Speaker:Exhale as you push up to the edge of the bed.
Speaker:Exhale as you stand up. That's going to help the deep
Speaker:tummy muscles. Do the work so that the pelvic floor can
Speaker:stay a little bit more relaxed. And then when you
Speaker:do exhale, when you sit down on the toilet, you might have an
Speaker:elevated toilet seat, which is kind for your, for the core
Speaker:muscles, but when the hips are kind of
Speaker:lower than so. So the ideal poop position
Speaker:is that my knee would actually be like higher than my
Speaker:hip. So if we're on an elevated toilet seat, we might ask a
Speaker:caregiver or a nurse to bring in a stool to rest our
Speaker:feet on. So we have more of like a 90 degree angle. And
Speaker:then we could put, typically we say pillows, but
Speaker:honestly that they're not, they're a little soft. So if the nurse could
Speaker:bring in like an extra set of sheets that have like a little bit more
Speaker:firmness to them and I'm sorry I don't have one with me right now because
Speaker:I didn't think we were going to talk about poop so much. Woo hoo. But
Speaker:we would sit on the toilet, elevate my knees up a bit. Those of you
Speaker:that are here watching, I'm giving a great visual demonstration.
Speaker:And then we would push the towel, the, the folded
Speaker:sheets kind of against the low belly while we just tried to breathe and
Speaker:relax the pelvic floor and, and that's setting
Speaker:up the system as much as possible
Speaker:to push that poop out. And essentially we never want to
Speaker:strain ourselves. And the medicines that you need
Speaker:to clear, you will need the stool
Speaker:softener in general to have that happen. So if you do have
Speaker:then the poop emergencies and the poop accidents,
Speaker:if we needed that drug to get the poop out, it is a
Speaker:common thing that might happen in the ICU or in, you know, the
Speaker:transitional. And just know that the nursing staff is there to help
Speaker:you. Don't be embarrassed. And then
Speaker:the next poop, as we wean off of those, we can do all of those
Speaker:good things that we just talked about. And pooping your pants, vomiting, it's all
Speaker:super stressful. So again, just coming back to can I just belly
Speaker:breathe? Can I tell my body this is super fricking hard and this
Speaker:sucks, but thank God I'm alive. And can I
Speaker:experience all of these feelings while relaxing my pelvic
Speaker:floor? While understanding that that collateral damage of the pelvic
Speaker:floor tightening is going to happen in response to all of this.
Speaker:So let's soften it. Oh my gosh. Game is everything.
Speaker:Wow, that was Quite the initial
Speaker:101. Yay.
Speaker:You guys are so welcome. And I know it's a lot, but we're going to
Speaker:do a lot more segments together for this February Heart and Pelvis Month. Pelvic
Speaker:Floor.com is the website where we have lots of blogs that
Speaker:are getting repopulated. There's going to be more and more dropping each
Speaker:day. Instagram
Speaker:therealpelvic Floored I take my job
Speaker:seriously and not myself, so I have a bunch of
Speaker:silly videos about all things pelvis.
Speaker:I have a small newsletter that's getting a big revamp in
Speaker:2025. Please access all of that
Speaker:information. We're going to do a lot more talks, but whatever
Speaker:questions you have for Boots and I please submit them because you are not
Speaker:alone. You are not the only person with this question so you asking that question
Speaker:is going to help so many others. You can work with me in
Speaker:person or online or I have a great blog about how to find a pelvic
Speaker:physio near you. That's amazing. If you have questions
Speaker:again, send us a message. Here's where you live, here's what you're wanting help with.
Speaker:I'm happy to physically help you connect with a pelvic PT in person near
Speaker:you. And then lastly, I do have online
Speaker:resources. There are some courses that you'll see as well as a newfound
Speaker:Treasure Channel chest that has a little bit more in depth information
Speaker:and exercises than the Insta and Boots and I as
Speaker:gratitude for you guys being here, you can use the coupon
Speaker:OHS2025 for
Speaker:25% off any of those online programs. And if you
Speaker:did do the Treasure Chest that would give you 25% off the first
Speaker:three months. So I sincerely hope that's helpful to
Speaker:to you Boots. Thank you from the bottom of my heart for having me here.
Speaker:This is so fun. I cannot wait to talk about poop
Speaker:more. I love talking about poop and to talk about
Speaker:erectile dysfunction as a primary risk
Speaker:factor for major cardiac event and. So much more
Speaker:and so much more. So if you are in hysterics
Speaker:now, just wait for the rest of the month. We can
Speaker:Talking about poop and sex and the vag and
Speaker:penises can be fun. It can be. It doesn't have to be shameful.
Speaker:So be sure to come back next week. I'm so excited
Speaker:and I love you. You matter and
Speaker:your pelvic floor is your best friend along with your heart. Come
Speaker:back next week.
