A poop problem. Right. If the doctor knows about pelvic

PT, which again, there's. Our success rate is 80%.

So we can help four out of five people that come into our door with

pee problems, prolapse problems, sexy time problems, poop problems we can

help without medication and without any nasty side effects of surgery

or medication. The one out of five that we can't help,

we educate the shit out of you so you now understand

your pelvis and you are essentially prehabbed for

success. Welcome to Open Heart

Surgery with Boots, where this February we're going

below the belt. That's right, we're diving

into the surprisingly connected world of heart surgery

and pelvic floor health in this five part series

series. Join me and our special guest expert, Dr.

Kelly Sudakis as we talk about everything you're too

embarrassed to ask your cardiologist. From what makes a

happy pelvis to getting your groove back after

surgery, to yes, even the great post

op poop debate. With candid

conversations, practical advice and plenty of laughs,

we're exploring the ups and downs of recovery.

Because let's face it, healing happens from top

to bottom. So buckle up for some real talk about the

parsif recovery nobody warned you about.

Hello, welcome to Heart Month on Open

Heart Surgery with Boots. I am your host, Boots Knighton.

Please give a gigantic welcome to

Dr. Kelly Sudakis who is coming at you

today from Drake's Idaho. I am down in Victor,

Idaho and Kelly and I have

known each other for quite some time and both of our

lives have taken all kinds of interesting and winding paths.

And here we are today and for the month of February

to bring you a whole series on the

pelvis and

and I cannot be more excited. And this is coming

on the heels of my four year anniversary of

open heart surgery. Oh my gosh, I can't believe that

Boots. And I

am just astonished that just now

at four years, I am finally learning about

what it means to have a pelvis, to take care of the

pelvis, what is a healthy pelvis? Because

lo and behold, thanks to you, I just recently

learned that open heart surgery affects the

pelvis and pelvic health. I wanted to bring you

on for the whole month of February for Love month

and Heart Month. Love Month. What is

more love than the heart and the pelvis, right?

Like the two primary pieces in Love month. So

thank you so much for having me boot. So a little more

about me, guys. I am a pelvic health physical

therapist. I have been in pelvic health my entire

Career, which is about 25 years now.

And I feel so blessed.

And in this calling, I really do consider it a calling to

reach people and helping people understand their

pelvis and their pelvic health, and helping them pee better and

poop better and have more fun in the bedroom. When you

can help someone with those things, you help them on a such a

deeper, more holistic level than just helping them with their shoulder

pain. So it's been such a personally fulfilling

journey. As with many other pelvic health

pts. Probably about 10 years into my career,

I was feeling a little overwhelmed and burned out

with patient load and having a huge wait

list and dealing with the insurance game. And so many people needed my

help. And I often had a wait list of two to

three months for people to come in to get help from me. And we'd

often help them in just one or two visits. So I began to think,

how. What can I do to reach more people? And

through a circuitous, amazing

journey. In 2020, I launched

Pelvic Floor with the vision to change the

world one pelvis at a time, starting with you

and how we're going to do that. The mission is to reduce

geographic financial psychosocial

barriers to accessing this information about pelvic

health. And boots, four years into your journey, you're

just learning about this. I meet physicians that are

50 years into their successful medical practices that have never

understood the relationship of pelvic health to

the whole body, you know, and so you are actually ahead of the

game for most. And I am so grateful that your listeners here are going to

get to learn about the pelvic floor and the heart

here in February, heart month. Oh,

today, though, like, before we get into all those deets, this is like, you

know, pelvic floor 101. Like, what the heck is a

pelvic floor? Right, right, right. Yeah. What

is it? And so, listeners, I've asked

Kelly to just treat us like we are

starting from scratch and treating me like I

have just shown up in her office for the first time and we're going

to take it from there. So this is like, we're not skipping over

anything. I have not seen Kelly for my pelvic floor, although

I do need to. And call me. I'm just going to be

overt about that. And that is okay. Like, this is going to be a

series of it's okay to talk about weird and

awkward things. It doesn't have to be weird and awkward, but

if we're thinking about one of the impetus of me starting this

podcast was. I didn't learn. I didn't get

instructions on how to heal completely from open heart

surgery. It was only focused on the heart and the

chest. And it didn't include the emotional, spiritual aspects. And it

definitely didn't include the pelvic floor. It didn't include

nutrition, which is why I had the whole series in October of

2024 with Michelle. And so the whole point

of this podcast is to help you find healing mind,

body, spirit, head to toe, front to back.

Amen, sister. So we're starting from scratch.

I'm starting with you listeners, so. All right, Kelly, I just

love it. Your office. I love it. Okay, let's dive

in. So if you were seeing me or another pelvic health physio

in person, we would do a detailed medical history about

everything that's gone through, everything you've gone through in your life, right? What

surgeries have you had, et cetera. We would

dive into, if you have a vagina, into your menstrual history

as well. When did your periods start? How regular were they? Were

they painful? We then are going to ask

questions about pee, poop, and intimate

functions, regardless of what type of pelvis you have.

And based upon those

answers, then that guides the

rest of the visit. So, Boots, you and your listeners, we're going to

just go through, number one, what's normal, and then we're going to

talk about the anatomy and, like, how of the bones

and the muscles and how they work to provide

that quote unquote normal function. And then

we'll get to the nitty gritty of what's not normal.

And, you know, what's not normal might be ludicrously common

in this world of pelvic health, but that doesn't mean

that we have to deal with it. Right? The, the incidence of pelvic problems.

So pelvic pain, problems with peeing and pooing, it is the same

incidence as back pain in the world. Eight out of 10 people

will suffer from some type of pelvic problem in their

lifetime. But here's the thing. When you have back

pain, the average time that it takes you to get care

is two to three weeks if it doesn't resolve. If you have a

pelvic problem, pain, pee, urgency, pee

leaks, poop problems of constipation or loose poops, sexual

problems. Your average time before you seek

care is five to seven years. And I would

honestly argue that that's five to seven years for someone with a

vagina. And someone with a penis might even go longer than

that for a multitude of reason. Reasons. And it's because

we think it's a normal consequence of aging. It's because we're ashamed and we

feel alone. And then worst of all, if we go to ask

for help and we're told by a medical provider that it is normal

and it just stops our ability to progress, which is so sad. So I'm

so grateful to be here to talk to you about these things. To number one,

improve awareness. Number two, encourage you to get your cute butts in

for help. And then, number three, we might even save some

lives by learning about a few pelvic changes that are shown

to pre. I exist before

heart issues. Oh, my gosh. Are we

ready? I am so excited. I feel like I

need to get, like, school supplies ready. And like.

Yeah, and we're going to be saying

penis and vagina and sex, like all the.

I mean, it's all the words that go with the pelvis. And I hope

you are listening to this and you're already, like, feeling

squeamish. I invite you to sit with the discomfort

because what I really want for you is complete and total

health. And that includes your pelvis, and it includes your

vagina and your penis. Can I say that? Yes. Yes, girl. And we.

We should do a whole nother talk about, I think the Latin origin of

the perineum is like that. That shall not be named

or something. Oh, my gosh. So then there's a whole nother talk about, like, purity,

culture and stuff. But we'll. That. That's for later. So first and foremost,

folks, what is normal in the pelvic floor? Because

to understand what's not normal, we need to start with the basic ground rules of

what is normal. Regardless of your age,

regardless of what parts you have in your pelvis,

we ought to pee on average once every

three to four hours while awake. And when we

pee, it should be preceded by a

gradual urge to pee, never a freight train.

Hey, get your butt to the bathroom right now. No, no, no. It should

start as a whisper that gradually builds up that we

eventually listen to on our own terms when we

start the stream, it should be very easy to start the stream.

To maintain the stream of pee, that stream should last

at least 10 to 15 seconds of a nice healthy stream. Per

pee following the stream, we should either give it a

wiggle or a single wipe and be able

to stand up if we're already standing, tuck things in, have

no post void dribbles, and then the cycle

resets. There should never be any Pee

leaks. There should never be any leaks associated with

urgency. Jumping, laughing, coughing, sneezing. That

should really never happen. Hmm. When we

finish peeing, we should feel satisfied. We should not feel like it burns

when we pee or that it burns afterwards.

In general, we should actually sleep through the night without awaking,

awakening to pee. And this is something that is considered

normal as we age, or doctors will even say it's normal during pregnancy to get

up at night to pee. And I would beg to differ. Like maybe we'll give

you one pee a night by like your third

trimester because then baby actually is settling down,

possibly in the first trimester because of the increased blood

flow. But in general, I want you sleeping. The

importance of sleep for overall holistic health cannot be

overestimated. And I want you to sleep whilst still

being hydrated. So yes, there are a few caveats within

this and I don't want you to dehydrate yourself

at all because hydration is important. So if I go through my whole day and

I haven't drunk enough water and I drink 32 ounces right before bed,

bed, in that particular case, I might need to pee at

night and it's better to be hydrated and wake up once and pee.

But if I'm only drinking 30 ounces during a

whole day, like that is woefully inadequate. I should not,

and I should not be waking up to pee that night. But I might be

because I might be dehydrating my bladder, but I'm getting ahead of myself a

little bit. And so all of that P function

should occur with us drinking this normal

amount of water which we take our body weight in pounds and we

divide it by two. So I weigh 160 pounds, so

I should be drinking at a base level 80 fluid ounces

every single day. 75% of that should be non

caffeinated, non alcoholic. Really. Alcohol

is just a chemical shitstorm. Like we should all be avoiding it at all

costs. And then if I am living in a high,

dry mountain climate, if I'm exercising, that base amount

needs to go up a little bit. So am I

having all those normal P functions while being adequately, hi

adequately hydrated? That's a really important thing to

check. Poop. The same muscles that

control the P function also control poop function. So what's normal for

poop? Poop has a little bit wider range. We

should poop anywhere from three times a week

to three times a day. And it needs to

be soft formed and non emergent.

As long as it's soft Formed and non emergent. We

sit down, we hopefully elevate our feet

up on a little stool, we relax our pelvic floor and

our colon pushes the poop, poop out. In

heart health, specifically Boots, this is a big deal.

If we strain to push poop out, we could

bring on a cardiac event. Not okay.

But in general health, it's just your bladder pushes your

pee out, your colon pushes your poop out. And if you have a

uterus and you're pregnant, your uterus pushes your vagina out or your vagina.

Oops. That was an oopsie. Your uterus pushes your baby out. And

if we're straining, then we actually can push other

stuff out that's not meant to come out like a hemorrhoid. We could cause a

bladder prolapse, we could cause some pee incontinence if

we're always constipated and pushing poop out. So that's

important. When you poop, are you able to sit down

and relax and have that poop happen? Like I'm in under one minute,

honestly, in general, and then it's

one or two wipes and we should be gone. We should be done. Like it

should not take half the roll of toilet paper to clean

up. And if it does, that's something that's called smearing and that's again

abnormal, something we can work on. And I have to

object that I do know someone know

of someone who died of a cardiac event on the

toilet at work. It was so sad.

Right, right. And we'll talk about that like, and like, yeah, if

we don't talk about it today, we're going to talk about it in one of

these segments. But like it's a big deal and it's something that we need to

talk about first and foremost from a primary health perspective. But

secondly, your listeners, this is open heart surgery with Boots.

So people that are here, we have a vested interest in managing this

arterial pressure. So if you've been a terrible pooper your whole

life, guess what, it's time to change. And it can get better.

And especially in the post surgical phases with

the medicines. Oh my gosh. Like, we really need

to understand what goes into poop. The whole

poop section. Again, there's so much we can do

nutritionally and hydrationally and musculoskeletally

to set you up for poop success. And the

greatest thing about all this is it's going to be overwhelming for some of you

listeners and just please don't be overwhelmed. You have access to this you can watch

this a zillion times. Take notes. You'll absorb what

you're ready to absorb. The same

specific and simple things that will help improve the pee

function, will improve the poop function, will improve the bedroom

function. So please just be kind and curious and not

overwhelmed with all this, because this is a lot of stuff that we're going to

cover in 30 minutes. Okay?

Sexy time. The bedroom is for two things.

Sleep and something else, my friends. And

something else. The intimacy. It should be pain

free, unless you want it to hurt,

but that's a whole different talk. But

intimacy should be pain free at the start.

You should be able to experience a pleasurable

rise to a climax, which should also be enjoyable and

pain free. And we should have no pain

afterwards. There should be no leaking of pee

or poop during intimate functions. And we

should not regularly have urinary tract

infections following. You know, there are some basic

things that, you know, with hygiene are good to follow.

But if you're always getting a UTI every time after you're intimate,

there's probably something else going on. And we're going to talk about

that in a moment. Oh, and you know, if you

are still menstruating, if you have a vagina and you're menstruating,

this is going to blow your mind. Period should be pain free.

What? Complete. Yeah, the.

Yeah, think. I'm just thinking about how

it is just. I'm just thinking about all my years. Like

I've been. Hold on, I just need a second. I know, right? I

know. Me too. I. So I am a double board certified doctor of

physical therapy, one of like 100 doctors of physical therapy in the world,

double board certified in pelvic health and orthopedics. I just

learned this less than 10 years ago, that periods are supposed to be

pain free. And I didn't even believe it when I think maybe even five

years ago, because my boobs have hurt my whole life

until I learned this. My labias, that's like the part you can see on

the side of the vag. Like, those would always be very sore. The second day

of my cycle made a few specific changes.

And pain free. It's insane. And we

don't know this. We normalize pain for women and it's not

okay. And when we can do things to control the

pain, which again, are a lot of the same things that I'm gonna talk to

you about, we can make your periods pain free. And if we

can't, and especially if they're debilitating, that can Be a

sign of a condition called endometriosis, which is something totally

separate. And you need to get your cute butt in for appropriate

treatment. There's a study of women, younger

girls, who ever missed school or work due to

period pain. Almost 100% of them have this condition called

endometriosis, which, which is super debilitating. And we are like, oh,

it's just period pain. And we, we just shove them. Oh, just take this

medicine. It's like, no, listen to them. This is a huge deal.

Well, and I was thinking about all the marketing from like the

ibuprofen, Aleve, Motrin, and.

And it just seems like it's just accepted. And that's just how it is. And

so you just have to take this and then that will make your periods better,

you know, and just how. I think I've had my period for maybe 30

years now. And I just assumed that that was just part of

being a woman. That's so infuriating. I know, right? Isn't it?

Isn't it? So we can. We'll talk about the things that we can do to

change that. So that is the basics of, like, what's normal.

Now, if you were coming to see me one on one, we would touch very

lightly on each of those. I would have on your intake,

though, your chief complaint, your reason for seeing me. So I might spend a

little bit more time on one of those items than the

other. We would then go into educating to the muscles

of the pelvis and the core and explaining how those

things happen. So we would begin with the bladder because

pee urges and pee leaks are one of the primary reasons that someone might come

to a pelvic floor. Physical therapist and your bladder. And

for those of you who can see this on video, we have your cute

little bladder here that kind of rests upon

a shelf that is the pelvic floor.

And that shelf, I'm going to hold up Patty, the pelvis here,

who is an anatomical model of the pelvis.

And essentially, white parts are bones, red parts in

general are muscles. And we have the bony

pelvis is like the structure of the house, the

drywall. You've got your low back in the very back,

and then you have a ring of pelvic bones that are made

of your two hip bones and your sacrum behind that

kind of form, this circle, right? That's base of your core.

You have tummy muscles that help dynamically

support this pelvis in the front and kind of connect the two

pelvic bones. You have butt muscles that go from the back

of your hip bones to your leg bones and back.

And, and from my humble perspective, most

importantly, you have this incredible hammock of

pelvic floor muscles that form the bottom of this

bowl. And those of you that can see, I know, right,

they go from the front of your sacrum all the

way to the back of your pubic bone. That is

quite right. And get this girl and

boys, everyone who's looking and watching, it's not just one

muscle on the bottom, it's a whole

group. And I highly recommend if you can check out the video

to do so at this exact minute, it's more than

13 muscles on the right and the left. Just like

you have right legs and left legs and this one here is a

vad. You can see the two holes, but penises are not that different

really. It's just this top hole is kind of closed. But they're mostly all the

same muscles internally, they all have different

roles. Constricting the urethra, the P

zone, elevating the middle of the perineum, which is that

muscular middle support controlling the rectum and back, helping you keep your

balance, right? And like what, it's

amazing that they ever work in the first place. And

truly. So you've got this cute little bladder resting

on that hammock and, and in real life,

this is the. And already right now, you listeners, you

boots know more about your pelvic floor muscular

anatomy than probably most primary care

providers. Just from this last three minutes, just. From that

last three minutes. Because most primary care providers in medical school

got one lesson on the pelvic floor that was taught by possibly a

pelvic floor physio, possibly just a physiological. And

then they went on to, quote, unquote, more important things,

right? They went on to medicines to help save lives, to

surgeries to help save lives. So this is not to minimize or say that they're

missing something, but they just had to go down a different road and they

never got this education. And now you

are though, and so you can be your own advocate. All

right, so we've got this cute little bladder resting

upon that hammock of pelvic muscles.

And the pelvic muscles are like an elevator in

a four story building. And they're

meant when they're super happy and healthy to rest on the ground

floor of this four story building. And then

with day to day life, the brain should automatically

decide how much muscles to use when you stand

and walk and run and pick up your groceries. And it should decide to

bring the Muscles up to that second, third, fourth floor and

back down again. When we sit down to pee or

poo, it should know how to relax them into the sub

basement and then come back to that ground

floor again. They're kind of like always on standby.

Pelvic problems, including leakage,

they primarily occur not because the pelvic floor is

sloppy and loose and open,

but because, for a variety of reasons, it starts to

rest too tight.

There's your second big mind blowing thing of the

day. Because for most humans, when you start to have

any type of pelvic problem, we are going to

do Kegels, and that's totally the wrong thing to do. Kegels

are the least important part of the pelvic perspective, and they will

typically make PE leaks, make pain, make sex

worse. Whoa. When I hear

that, that's like the main treatment for everything. And

who told you that? Yeah, I mean,

I. You just. You just know. Yeah, you

just. Isn't that funny? You just know. But here's the dirty

truth about Kegels. People were just told to do

Kegels because, oh, if you're leaking, yes, clearly the

pelvic floor must be weak. So you should tighten them in the 80s.

So this is the 80s. There's not even cell phones yet. All phones are still

connected to the walls. Right. There was a landmark study by

Bump et al that told people

to do Kegels. Then they followed up and they found

that just telling someone to do Kegels, if you had 100

people, by sheer luck, 1/4,

25 of those people would get better. However,

the same amount, 25%, would actually get worse and

half of the people would not see any change. And

that's because there was no actual education

connection to the muscles. So let's bring it back

to our elevator analogy, right? The

way the body reacts to pain,

dysfunction, and stress. And boots

your comment in the opener. In your open

heart surgery journey, you were not treated holistically. You did not

receive this education into what happened. Beyond the physical

heart. The pelvic floor has a direct connection

to your amygdala, which is your emotional center of

your brain. If we show a college age woman with

no history of abuse or stress.

Stress beyond life. A picture of a dark

parking lot. Her pelvic floor will clench because it senses the

potential for danger. Whoa. This is a survivalistic

standpoint. If we are physically stressed, emotionally

stressed, the amygdala tightens. The pelvic floor brings

this elevator up to the second or the third floor as a

sympathetic fight or flight response to help us get ready to run away from this

tiger. Right? And now like, what is.

And heart surgery is stressful, My Lantai. It's

stressful, right? Life is stressful.

That's going to start to bring this up to the second floor. And it's something

that happens that we're not cognizantly aware of. Right? So, so we

don't. If I say, relax your pelvic floor, you think it's already relaxed.

So now I'm resting on the second floor here. My pelvic floor is doing too

much work all the time. That's going to irritate my

urethra, that's going to maybe annoy my bladder, so it

starts to send a more urgent signal. And depending on

everything else that's happening upstream, that

now that these muscles are doing too much work all the time, they might not

have energy to hold my pee in when I need to

and I might start to pee my pants. And now we

have this like net downward spiral. Now that's stressful.

I might, because I quote unquote know that I'm supposed

to do Kegels, I might try to tighten up more. And now,

now I'm resting on the fourth floor and lo and behold, my urges and my

pee leaks get worse because the problem's not that my muscles are

so loosey goosey that I'm. I've been in a wall sit for

18 years and now I'm asking myself to go run a

marathon. Like, it's so sad.

Well, and I hate wall sits.

And I have. And I have really silly Instagrams. I'll get you the links

that we could put under about how these tight muscles can cause

leaks, but they also cause pelvic pain

with intimacy because they close the door. Essentially, they cause

us be to be unable to climax because the muscles that are

associated with climax are high performance muscles. So if they're

not healthy, we're not going to be able to build into a climax. We're not

going to have one. If we have a penis, we might not be able to

have an erection. And that's a huge deal that we're going to talk about in

the next segment. It's an independent risk factor for major

adverse cardiac event, period wise. Guess what? Are you

ready for your third mind blowing topic? Okay.

It's been mind blowing for 30 minutes already. Like, oh no, it's already 30 minutes.

What? We might have to divide it into two. Not just saying all of this

has been mind blowing. So. But we need this Is why we need to talk

about it, because there's so much. Right. So here's these sweet pelvic muscles

again. For those of you that can see, I just showing the. The. The in.

I'm inside the belly, looking down. There's all these different pelvic muscles. Here's a

vag. Guess where these muscles. I'm pointing to the muscles kind

of on. I. Oops. That was the rectum. I'm. Trust me, I'm a doctor. Here's

the vag. These little muscles on either

side of the pelvic floor. You know,

if you have a heart attack, where do you feel the

pain? By common knowledge, boots, Is it in your heart or

is it. Could it be elsewhere? Well, the two I've had,

yes. My left arm, the first one. My left arm, my

chest. But the second one here was. Here's the crazy

part. The second one, I had no pain, but I had

stopped peeing. No. Oh, my gosh. Okay. That's wild. I

can't wait to dive in. So first one, had we worked on your

arm, it not only would not have helped, but you might have

died. Right? Like. Like not understanding where the pain was

coming from. These pelvic floor muscles that live on

either side of the vagina and then even further back towards the rectum, their

referred pain pattern, they don't tip it. They could hurt in the vulva.

Sometimes they could hurt in the pelvic floor. They're more common.

Referred pain pattern is the lower abdomen.

So that's where your period cramps can come from.

In the absence of endometriosis, the pelvic floor resting too tight.

During the period process, there's increased inflammatory chemicals.

Everything's resting just below the pain threshold. Here comes the period. Here comes the

chemicals. Boom. We cross the pain threshold, and we can put a hot

pack on our lower bellies as much as we want. And it might help a

touch, but we actually need to do is relax. The pelvic floor,

dude. Wild, right? I know, I know. And then the third

hole moving backwards, you know, is the rectum back there. So we have

that sweet rectum. Where. Where's my rectum gone

to? There it is. Found

it. Does it have a name? Because we've got Patty Pelvis.

Patty the rectum does. I have Patty the pelvis. And it. It

alternates between Peter the pelvis and Philip the pelvis. The rectum

doesn't have a name, though. I should name it Randy. Randy the

rectum. I.

All my friends named Randy out there. Just going to Tell them that I just

named my rectum Randy. Yeah, yeah, you heard it. You heard it here

first, people on open heart surgery. Boots. Yes,

Randy. Yes. Ran random Randy. The rectum has been named

and I like it. We're keeping it. So you got the rectum back

here. And remember that hammock of pelvic muscles, right?

Same thing happens back here. It's meant to rest on that

ground floor, come up to support our pelvic pressure during

life, relax to give the on switch

to the colon to push the poop out when

that pelvic floor starts to elevate in response to

life stresses, in response to physical pain, in response to,

oh, gosh, I'm having pee problems.

Now we not only have the problem that it's much

harder to relax and open the door to give the on switch for the

colon to push the poop out, we're also engaging a

backwards reflex called the rectal anal inhibitory reflex.

We'll talk about this in the poop one. But we're engaging a reflex

that the brain thinks we're running away from a tiger and we don't have time

to stop and poop. So the brain's going to push the poop back up the

tube to give us a little bit of time to escape the tiger.

But that's meant to be like a very short term solution. So

what if we're resting up on that second or that third floor for days, weeks,

months, years on end, our poop is always getting this

negative signal. And so that's going to elicit,

typically more of a constipated trend. So the

poop's going to be harder to come through. It's going to be harder for us

to relax and give the signal for the colon to push out.

And then if we're straining to force the poop

out now there's all the other problems, the collateral damage, so

to speak, for the heart system and for the pee and the vag, if

we have one. Right. So the key in all of

this is to, number one, understand that because before

these last 30 minutes boots, have you known any of

this? None. And you

are a very educated woman and you are in

this heart surgery world and you're an active human. And

like you, you've had a period your whole life. So isn't it just mind blowing

that we don't know this? Well, I mean, I think how

unfair it is. It just leads to so many

unnecessary mind, body, spirit

issues that could be so

avoided. And, you know, just, just to like, talk about how I'm

educated. My undergraduate degree is in biology.

My graduate degree is in education. I

taught high school science, so it's not.

And I also taught at the collegiate level. I'm naturally

curious. I'm almost 47 years old and I

am just now learning this. So I just want to lay

the groundwork of really, what the

fuck? Exactly, exactly. And you

think about what happens. So we look at all these studies about

that gap in care that like, for most people, they're going to wait at

least five to seven years before they talk to a physician about their

pee problems specifically. And then depending on that

physician's education, like, what are they going to do?

Like now, if that person isn't watching this podcast, if they're not

following me on social media, what if that physician's like, oh,

here's a pill that's going to like, let's

say it's pee urgency, that's going to calm down your bladder. Does that

fix any of this musculoskeletal stuff? It doesn't.

And it's not without risk. There is the same things that that pill

works on to relax your bladder. It interferes with your cognitive

function. And people don't know that. There's not like, informed consent. A

poop problem, Right. If the doctor knows about pelvic

PT, which again, there's. Our success rate is 80%.

So we can help four out of five people that come into our door with

pee problems, prolapse problems, sexy time problems, poop problems. We can

help without medication and without any nasty side effects of surgery

or medication. The one out of five that we can't help, we

educate the shit out of you so you now understand your

pelvis and you are essentially prehabbed for

success for whatever that next step might be. And we can help

guide you to, hey, based on our experience, this should be

the next step because surgeries are not always bad. Open heart surgery

saved your life, prolapse surgery, bladder surgery, sometimes you need a

colon surgery. They're all amazing in the right place. But

just like you would never have a knee surgery like

an acl and then be like, oh, well, just rest six months, you'll

be fine. Like, you'd maybe survive, but you would not

thrive. You should never have a pelvic procedure.

Ideally, we'd always have prehab. But you should never have a pelvic procedure

without post operative pelvic floor physical

therapy. And that includes appendectomies,

gallbladder surgeries. That includes open heart surgery. I know it's not a

pelvic surgery, but it's a whole body surgery, and so that

should be a part. And it's not yet a standard of care. But

we just talked about what happens to the pelvic floor in response to

stress. Right. There's not much more stressful than open heart

surgery. I just wanted to interject in that because. And I'm going

to get real personal here for a second. Yeah, yeah.

I'm thinking post op for me. And if you, if you're

just now finding this podcast, first of all, I'm tickled you're here. You're here.

Thank you so much. And I hope that you will

subscribe and you'll visit our Patreon and you'll go back and

listen, because I've been building a whole network of

resources for you heart patients and

caregivers for, for thriving post surgery.

But I, I bring that up because I want you to go back and listen

to my story in episodes one and two. And I

definitely talk about the first few days of just

how my body needed to purge. And one thing I wanted to bring up,

you know, I. I threw up 25 times post

sternotomy, which was just hell on earth. But

then I obviously couldn't poop. And one

question I have for you, Kelly, is, you know, you hear about

post surgery, you can't poop. And granted, I had the

P tube in for a few days getting the fluid out of me, and that

was fine once it came out, but I couldn't poop and

I needed to poop. I knew I needed to poop. And so then I drank

a diuretic. But then I made it.

I. Then I couldn't control it. And so I just like to

say I took advantage of all the CNAS on the floor.

That's why they're there.

Exactly. But it was like such an

intense experience. And if we, you know, in these last few

minutes of this first installment talk about that,

because, yes, it is so important to poop post

surgery because I. I have two

pages, single spaced, font size

10 list of all the medications that were put into my body

during open heart surgery that needed to come out.

Right, Exactly. No, this is such an important part of

the discussion Boots. And we should do, you know, we'll do like a whole thing

just about pooping, but in general, the key things that

you can do, there is a very simple,

easy belly massage that we could start. And we

honestly should start these things that I'm about to say we should start them

pre open heart surgery as well, because they are all going to be things to

help connect to this pelvic floor and calm it back

down. The one additional part that also contributes to that tight

pelvic floor, beyond the physical stress and the emotional stress of the

surgery. Breathing, Right. How after a

sternotomy, how was it to breathe?

Suzanne, you had respiratory therapy, right? Like so.

Yeah. Breathing's hard and we're not going to get into too

much except to blow your mind. A fourth, possibly final time of

this talk. The pelvic floor muscles are an accessory

muscle of breathing, which means that in their. Yes,

that in their perfect state, when we are relaxed and those cute

little pelvic floor muscles are down here, I got Randy the rectum. When they're

down here on the ground floor, we're totally relaxed. You breathe

into your belly and your belly gets bigger and you exhale and

your belly gets smaller. Diaphragmatic breathing core of every

post open heart surgery, do they ever once say,

hey, tune into your pelvic floor as you inhale

and your belly gets bigger. Your sweet little pelvic floor is up here on the

third floor. Can we inhale? Belly gets bigger. Pelvic

floor drops towards the ground floor. Can you exhale?

Belly gets smaller. Pelvic floor stays

relaxed. That was never mentioned.

Of course it was never mentioned. And we are, pelvic pts are making great

strides in OB floors, finally coming in to

see women post baby, post cesarean. Hugely important. It

is just as important for us to start to have a presence on open heart

surgery floors and in the ICU or even collaborating with your

respiratory therapist. But that singular piece of

belly breathing, step one, again, pre heart surgery, we

are super stressed, right? If we are able to, if it's

not this emergency thing, we know this is coming. We're very stressed. Our pelvic floor

is going to be up here. So we owe it to ourself to do some

of that diaphragmatic breathing to stimulate your

parasympathetic nervous system, the calm the rest and digest

system to bring the pelvic floor specifically down

to not irritate the bladder or Randy the rectum

here. Now, so that's one thing is this belly breathing we can do and

we can start that as soon as we are out of

surgery. The second thing is a very simple belly

massage. And what will physically happen is at first you're going to

say, well, I can feel that belly moving, but I

can't feel anything back here. And that's just curious. We're

not angry that we can't Feel that. But we're simply curious. And that's going to

give our brain permission to try to find those nerves, because I guarantee they're

there for you. Um, in a future one, we'll go over the exercises, but just

being aware of that and possibly even sitting on a little rolled

towel vertically. So a little pressure on the vag or the

part behind the scrotum, a little pressure on the rectum. Inhaling, try

to encourage those pelvic muscles to come down. Is huge.

Secondarily, belly massage. Um, those of you that can see

me, I'm going to stand up here. Here's my belly. You would have a

big old incision here. We would be laying down. And this is my

belly button. This is clockwise. I never

know what direction my video shows up. But we

would be laying down. Relax. And we would do gentle pressure,

gentle circles in a clockwise direction. This

is called sunflower massage and old

school, I love you massage.

Fine. It's better than nothing, but I'm going to give you something better. Old school

I love you massage is you would do an I coming up from

the right hip here, and then an L up and

over and then a U and. And that's

fine. And the theory is that you're helping to move the

poop through the tubes. I want to be very honest that

in real life, you're simply mobilizing the nerves and the blood vessels. But it has

an exquisite benefit. Okay, so you would

spend three to five minutes of this sunflower massage just

feeling your tummy. And it should feel like soft

bread dough. And you might get to a spot like right

here. Mine's not moving the greatest. Right there. That's

interesting. So if I was having any poop

issues, that would be good for me to just gently work on. We would never

poke into a spot that was sharp pain. If for any

reason you had any insertion, like, you know, any

ports in here during your surgery, then we wouldn't want to be doing this.

But in open heart surgery, we normally don't. But we would

do this three to five minutes of this belly massage while belly

breathing. Okay. Then we would follow it

with the PT version of digestive massage,

which is actually going to start at the outhole. So,

Randy, the rectum here. I didn't talk about this at first.

We just talked about where he was in relation to the pelvic muscles. He's

actually turned 90 degrees. So your

poop at the end of its journey through the tube has to make two turns,

90 degree turns, and that's kind of unfair. That's called your

sigmoid colon. But to clear that, you're going to

go find your left hip bone, you're going to come to the inside of

it. You're going to push in and then pull towards a

line between your belly button and your

pubic bone. So you're going to push in, pull here, and then release and

you're essentially clearing the sigmoid colon.

We might be pulling poop into the final holding

stage. In reality, you're massaging all the nerves that are going

to that colon and helping it move more freely. And

you're going to do that three to five times while belly breathing and trying to

relax your pelvic floor. And now we've

opened the door a little bit of the pelvic floor. We've softened

it to take the brakes off the colon. We started to move

here. Now we can push here. And this is something that if your arms are

tired, if this amount of pressure is sore from the sternotomy,

your A partner can help with this. You can use a silicone massage

cup three to five times, pushing downwards to

help the poop down the descending colon. And again,

in reality, just mobilizing all the nerves that are going to the descending

colon. We would then do transverse colon. And this

depends on how low our incision is. Right. So we're always going to be healthily

below the incision. And we could even have a second hand on the bottom of

it to make sure we're not disrupting that. And we would go three to five

times across. And it doesn't matter that my actual colon is like up here

and way back there. This is the nerves that are going to the

colon that we're working on, people. Then second to last is

ascending colon. I start at the lower right and I pull up

and the whole time I'm just any place where I've just created space. Now I'm

encouraging poop to move towards or I'm encouraging the

nerves to be healthier. Final one is your cecum, where

your small intestine meets your large intestine. And it's the mirror

of our first one. We push to the right and pull over

three to five times, Doing that

relaxed breath frequently throughout the

day. Doing that colon massage two or three times a

day. And then when you move, exhale

with exertion. Exhale as you log roll to the side.

Exhale as you push up to the edge of the bed.

Exhale as you stand up. That's going to help the deep

tummy muscles. Do the work so that the pelvic floor can

stay a little bit more relaxed. And then when you

do exhale, when you sit down on the toilet, you might have an

elevated toilet seat, which is kind for your, for the core

muscles, but when the hips are kind of

lower than so. So the ideal poop position

is that my knee would actually be like higher than my

hip. So if we're on an elevated toilet seat, we might ask a

caregiver or a nurse to bring in a stool to rest our

feet on. So we have more of like a 90 degree angle. And

then we could put, typically we say pillows, but

honestly that they're not, they're a little soft. So if the nurse could

bring in like an extra set of sheets that have like a little bit more

firmness to them and I'm sorry I don't have one with me right now because

I didn't think we were going to talk about poop so much. Woo hoo. But

we would sit on the toilet, elevate my knees up a bit. Those of you

that are here watching, I'm giving a great visual demonstration.

And then we would push the towel, the, the folded

sheets kind of against the low belly while we just tried to breathe and

relax the pelvic floor and, and that's setting

up the system as much as possible

to push that poop out. And essentially we never want to

strain ourselves. And the medicines that you need

to clear, you will need the stool

softener in general to have that happen. So if you do have

then the poop emergencies and the poop accidents,

if we needed that drug to get the poop out, it is a

common thing that might happen in the ICU or in, you know, the

transitional. And just know that the nursing staff is there to help

you. Don't be embarrassed. And then

the next poop, as we wean off of those, we can do all of those

good things that we just talked about. And pooping your pants, vomiting, it's all

super stressful. So again, just coming back to can I just belly

breathe? Can I tell my body this is super fricking hard and this

sucks, but thank God I'm alive. And can I

experience all of these feelings while relaxing my pelvic

floor? While understanding that that collateral damage of the pelvic

floor tightening is going to happen in response to all of this.

So let's soften it. Oh my gosh. Game is everything.

Wow, that was Quite the initial

101. Yay.

You guys are so welcome. And I know it's a lot, but we're going to

do a lot more segments together for this February Heart and Pelvis Month. Pelvic

Floor.com is the website where we have lots of blogs that

are getting repopulated. There's going to be more and more dropping each

day. Instagram

therealpelvic Floored I take my job

seriously and not myself, so I have a bunch of

silly videos about all things pelvis.

I have a small newsletter that's getting a big revamp in

2025. Please access all of that

information. We're going to do a lot more talks, but whatever

questions you have for Boots and I please submit them because you are not

alone. You are not the only person with this question so you asking that question

is going to help so many others. You can work with me in

person or online or I have a great blog about how to find a pelvic

physio near you. That's amazing. If you have questions

again, send us a message. Here's where you live, here's what you're wanting help with.

I'm happy to physically help you connect with a pelvic PT in person near

you. And then lastly, I do have online

resources. There are some courses that you'll see as well as a newfound

Treasure Channel chest that has a little bit more in depth information

and exercises than the Insta and Boots and I as

gratitude for you guys being here, you can use the coupon

OHS2025 for

25% off any of those online programs. And if you

did do the Treasure Chest that would give you 25% off the first

three months. So I sincerely hope that's helpful to

to you Boots. Thank you from the bottom of my heart for having me here.

This is so fun. I cannot wait to talk about poop

more. I love talking about poop and to talk about

erectile dysfunction as a primary risk

factor for major cardiac event and. So much more

and so much more. So if you are in hysterics

now, just wait for the rest of the month. We can

Talking about poop and sex and the vag and

penises can be fun. It can be. It doesn't have to be shameful.

So be sure to come back next week. I'm so excited

and I love you. You matter and

your pelvic floor is your best friend along with your heart. Come

back next week.