Dr. Jocelyn Wallace [00:00:00]:

It doesn't have to be pain as you define it, but if you're feeling that, like like, someone's standing on your back while you're trying to run or do a plank, for example, like, there's this pressure, there's heaviness, your muscles probably aren't ready for the thing that you're trying to do.

Georgie Kovacs [00:00:14]:

Welcome to Fempower Health. This is Georgie. Today, we delve into the critical topic of the impact of hysterectomies on pelvic health. Joining us today is Dr. Jocelyn Wallace, a doctor of physical therapy, pelvic floor specialist, and a long time fitness coach. Dr Wallace is on a mission to redefine the care that people receive before and after pelvic surgeries. She is dedicated to helping women find healing after a hysterectomy, enabling them to return to the activities they love with safety and confidence. In this episode, we'll explore proactive steps to take before a hysterectomy and the essential support needed afterward. If you're looking for an expert to guide you on managing the effects of a hysterectomy, you've come to the right place.

Georgie Kovacs [00:01:05]:

So, Jocelyn, thank you so much for joining me on Fempower Health. It was such great timing that you reached out to talk about pelvic health and hysterectomies because I am speaking with a clinician out of Mount Sinai, and we're going to be talking about all the myths and facts around hysterectomies. And over the years of doing the Fempower Health podcast, I've learned so much about all these things related to our pelvic health that we don't always know about until after the fact. And there's so many things we can be proactive about. And quite honestly, I never thought about hysterectomies and and pelvic health and being proactive. So I was really happy, that you reached out to talk about this topic. So why don't you, introduce yourself and, tell us your background, and then we can talk about all the awesome things women need to know about.

Dr. Jocelyn Wallace [00:01:51]:

Yeah. Absolutely. Thank you so much for having me today. My name is Jocelyn. I'm a doctor in physical therapy and a pelvic health specialist. I started working in the pelvic floor space because I myself have had fibroids for over 10 years. I've had 2 surgeries to remove fibroids, and I saw the hole in care for people who had these gynecological health disorders outside of things related to pregnancy and perinatal topics. So I had no guidance on how to get back to exercise after surgery, no guidance on what to expect from my pelvic floor.

Dr. Jocelyn Wallace [00:02:23]:

It also just having fibroids, which can do a lot to the pelvic floor, but also healing from 2 major abdominal surgeries. So So that's what inspired me to get into the pelvic floor space. And over my career in working in pelvic floor for about 5 years now, I've started to kind of niche down to working with only hysterectomy, myomectomy, and endometriosis excision surgeries to help these people that are dealing with all these public health issues that are not related to perinatal topics.

Georgie Kovacs [00:02:52]:

So give us this background on, like, why the pelvic health area is so important and tied to these surgeries and why what it is that we need to be managing, like, structurally, what's happening here?

Dr. Jocelyn Wallace [00:03:06]:

Yeah. So the pelvic floor is so important because it's involved in everything that we do. Every lap, every step, every exercise, it's involved in every movement that our body makes, even every breath that we take. So it can be the first place where we notice problems. It can also be a very intimate area that people we don't receive the education we need to understand when something's going wrong and when it's it's not. So it can be a place where people will tolerate pains and discomforts and incontinence and things like that. They'll tolerate it for longer than they might tolerate their knee pain because they don't know where to turn. They don't have the language to apply to it.

Dr. Jocelyn Wallace [00:03:42]:

So in order to help women with these surgeries and with disorders like fibroids and endometriosis, I had to get the education to be able to screen for public health issues and help people with public health issues, but it can really affect so much more than that. So there's also back pain and issues with the abdomen and hernias and things like that can that can occur from these surgeries. But it's the pelvic health piece of it that's the most underserved because we don't have the awareness. We don't have the language unless we have this education.

Georgie Kovacs [00:04:13]:

I I almost wanna start with, like, a comparison contrast to help people understand the role of the pelvic, air pelvic floor and and pelvic health in this, in these specific examples. So I think hysterectomy But with endo, just given what it is you're removing and, But with endo, just given what it is you're removing and likely where, it's like, would someone necessarily think I should be proactive about my, pelvic health? And so I don't know if you wanna maybe take I don't know if it's one explanation for both extremes, or if we wanna take each of them and give some specific examples of things that can happen if we're not proactive or why structurally it matters, to be proactive about your, pelvic health, in light of these surgeries.

Dr. Jocelyn Wallace [00:05:05]:

Yeah. So the the to break it down to the just the simple roles of the pelvic floor, it's sex, sphincter, and support. So they close our holes and keep things in when we don't wanna pass things. They contribute to sexual function and sexual pleasure, and they support our pelvic organs. So when there's pelvic floor dysfunction, any one of those three sections of our lives can be affected. So we can lose support where we feel pressure or back pain or, a feeling of, like, something falling into the vagina or the rectum. We can have issues with sexual pleasure and sexual function, including pain with sex or loss of sensation and just loss of pleasure with sex, and we can lose the sphincter functions of the pelvic floor, so we can lose urine, gas, or stool when we don't mean to. Endo and hysterectomy both can come with dysfunctions in any of those realms.

Dr. Jocelyn Wallace [00:05:56]:

There are certain things that are kind of more common with women who have endometriosis and maybe haven't had a surgery for it yet. They typically deal with a lot of pelvic pain, a lot of tension related problems versus women who've had

Georgie Kovacs [00:06:09]:

a hysterectomy. The big things are prolapse and incontinence that people worry about and that people experience. I will just say this, and I don't wanna go down a rabbit hole, but one thing that's really fascinating to me about women's health and health in general is just how interrelated things are. It's like when you spoke about hysterectomy and incontinence. So we know also that when you have a hysterectomy, you have that significant drop in hormones, and you're sort you're basically now in menopause. Right? And I know that, some of the experts I've interviewed, we've talked about genitourinary syndrome of menopause, and you really wanna be taking vaginal estrogen to be proactive. But I would assume also structurally, because it's not just the hormones that you're lacking because of the hysterectomy, but now structurally, you have a change in your body, which now could also impact the incontinence. Right? So it's Yeah.

Georgie Kovacs [00:07:03]:

Kind of a dual complication.

Dr. Jocelyn Wallace [00:07:06]:

Yes. It's a both and situation, but in some scenarios, having hysterectomy can help incontinence. If someone has huge fibroids that are putting pressure on everything, they can't fully empty their bladder, having hysterectomy can be part of the path to improving their incontinence. But it's absolutely it's a both and situation. But all women, our pelvic floors get weaker with age. We lose our muscle mass as our estrogen drops. All women should be worried about structurally strengthening all of the surrounding muscles around the pelvic floor and the pelvic floor itself for sure.

Georgie Kovacs [00:07:38]:

Let's say you are in a situation where you need to get a hysterectomy. What is it that you need to be doing in advance to prepare for that?

Dr. Jocelyn Wallace [00:07:46]:

Yeah. There are so many things that we can do to help the experience be easier. The if I could just choose one thing, it would be to start thinking about stress reduction and taking load off your plate before surgery. Don't try to do do do everything until the minute you're under the knife so you go into surgery in this, like, high stress, high anxiety, feeling. Offload your plate before surgery. Ask for help where you need it. Get your house cleaned if you can. That just that kind of thing can make such a difference to your state going into surgery.

Dr. Jocelyn Wallace [00:08:19]:

From a more pelvic health specific, perspective, dealing with any symptoms that you do have can help so much. So if you're dealing with extreme urinary frequency from whatever is leading to your surgery, There's things that we can do to help ease those kinds of symptoms before you even have surgery. Constipation is one of the biggest things that you can ease that will reduce the strain on your pelvic floor. And I see too many women that are they're afraid or hesitant or feel like they're tougher if they don't take the stool softeners, don't use the fiber supplements, and they should just push through it. But your body sometimes benefits from using those things so you can pass stool more easily and get past constipation more easily, and you can go into surgery with your pelvic floor in a less strained place. So using those kinds of tools to deal with whatever kinds of symptoms you already have, keeping hydrated. A lot of people, especially if you're dealing with something like fibroids or something that's causing urinary frequency, and that's why someone is ending up having their hysterectomy. Often, people will start drinking less and less and less because they wanna go to the bathroom less.

Dr. Jocelyn Wallace [00:09:26]:

But concentrated urine can actually be a bladder irritant and can send you to the bathroom even worth more, and it can be a vicious cycle with urinary frequency. And that constant urination can also be a strain to the pelvic floor, especially where it starts to become so bad that women are having trouble fully voiding, and they're starting to push and bear down to their pelvic floor in order to fully empty their bladder and feel like they finished going all the way. So dealing with those small things can help bring your pelvic floor into a better state going into surgery. And then if someone does have incontinence, you can start strengthening and doing work to help the incontinence before surgery, and that just puts you in an even better place for after surgery. And, absolutely, if someone has access to it, going and getting a pelvic floor evaluation with a pelvic floor physical therapist so they can start working on things like that. Because it's not always key goals and just strengthening that someone needs that they have incontinence. Sometimes there's an element of muscle tension, and they need to first learn how to relax and lengthen the pelvic floor so that they can get an efficient con contraction in order to deal with incontinence. So the best place to start is looking at what you're actually experiencing, and there's always something you can do to deal with those kinds of symptoms.

Georgie Kovacs [00:10:44]:

Right. Now you were mentioning constipation. And so, can you is it I guess I wasn't sure the relation of constipation and the hysterectomy. Is it that some women, because of a condition that they may have, will get constipated and they have to do preparation before the like, what is the path and and relation there? I wasn't clear.

Dr. Jocelyn Wallace [00:11:06]:

Yeah. So absolutely, there are some conditions like large fibroids that can delay or inhibit passage of stool, and it can create constipation. So sometimes those women need to use stool softeners to help. There's also just a lot of women that deal with constipation in general, and it's not good for our pelvic floors. It's not something that I think we should just normalize. There's a lot of tools out there that can help with constipation. Constipation can also be common for people that have had other abdominal surgeries. And, typically, by the time someone's getting a hysterectomy, they have lived a life.

Dr. Jocelyn Wallace [00:11:38]:

So they may have had other c sections, and they may have had their gallbladder removed. They may have other things that have happened to their abdomen that's created a situation where they're starting to get more constipated more frequently. And even if it's not related to their pelvic floor or whatever is leading to the hysterectomy, if they are experiencing constipation regularly, doing whatever needs to be done to help deal with that can help put their pelvic floor in a better state because they're not constantly straining.

Georgie Kovacs [00:12:05]:

Just structurally, what can happen to the body that people should just be aware of. Because I think sometimes if we know what can happen after, it'll make us be

Dr. Jocelyn Wallace [00:12:13]:

Yeah.

Georgie Kovacs [00:12:14]:

More likely to be proactive beforehand to prevent that. Yeah.

Dr. Jocelyn Wallace [00:12:18]:

So the the most common hysterectomy these days is the removal of the uterus and the cervix and the fallopian tubes. When they can, they leave the ovaries intact. Something that a lot of people don't realize is that all of our organs have ligaments. They're not just floating around inside of us. They have ligaments that attach to our abdominal wall and other organs around them. So when they they remove the uterus, they cut the ligaments that hold the uterus in place in the abdominal cavity. So you lose some of the support structures, not just the uterus, but also some of the support structures around the uterus when you have a hysterectomy. So you do lose some support for the pelvic floor.

Dr. Jocelyn Wallace [00:12:58]:

You also have lost the buffer between your bowels and your bladder, so things are gonna shift and have different pressures because that organ is going away. A normal uterus is quite small. It's smaller than your fist. So, for example, if someone is having a hysterectomy as part of a gender transition, they're having a very small uterus removed, and they might not feel as big of a change to their body as someone that has had an enlarged uterus with large fibroids or chronic inflammation for a long time, they're having a bigger than normal organ removed, so they're gonna lose more support. Typically, the cervix is also removed, which has its pluses and minuses, but the the having the cervix removed also removed some of the support, and then they close off the top of the vagina that's called a vaginal cuff. They close it off with sutures. So you've lost some support there, and now the the top of the vagina is the barrier between, you know, the outside of your body and the inside of your body. So while you have lost some support, we can rebuild that support via muscles.

Dr. Jocelyn Wallace [00:14:01]:

Something that also I don't think it's said enough about the pelvic floor is that our pelvic floor is muscles. It's muscle tissue just like your bicep. And if you had a bicep, a weak bicep or bicep tendonitis or had a bicep injury, you would totally expect that you could strengthen it and get that bicep stronger and healed if you wanted to. We can expect the same of our pelvic floors. If If we wanna get them stronger, we wanna get them healed. If we do the work and get have the patience with our body, we can expect them to heal, Expect it to heal just like any other part of our body. So we can do a lot to make up for that loss of support that comes from having the organs removed.

Georgie Kovacs [00:14:40]:

Are you finding that I guess, how frequently are people who are getting hysterectomies being referred to pelvic health experts?

Dr. Jocelyn Wallace [00:14:49]:

Yeah. Good question. It's getting more common. Absolutely. The surgeon that I work with, the the, like, the surgeon that's done my surgeries, she has pelvic floor physical therapy in her office she has pelvic floor physical therapy in her office. So she refers people if they ask for it and if they're having any kind of problem, but it's not standard of care yet to do it from a preventative or proactive place. I absolutely think that it should be. And I also think that a lot of people are walking around with issues that they don't even realize pelvic floor therapy could help.

Dr. Jocelyn Wallace [00:15:19]:

So they're telling their doctors, oh, yeah. Everything's okay because they're not feeling pain.

Georgie Kovacs [00:15:23]:

Right.

Dr. Jocelyn Wallace [00:15:24]:

But everything's not okay. They're having all of these other symptoms that they don't even realize a quick referral to pelvic floor therapy could help with.

Georgie Kovacs [00:15:32]:

As you're explaining this, all of it is incredibly logical, and it's quite honestly something I've just never really put together, like, specific to hysterectomy. So so when the cervix, is also removed and they have to stitch you together, like, one of the things I was thinking of is, like, sexual health wise and incontinence and all of all of these other things. I may not even be thinking of everything. Like, without pelvic floor physical therapists, I I don't understand how someone could easily go back to normal. I feel like so many it is common where they're like, I didn't know this was gonna happen. So talk to me.

Dr. Jocelyn Wallace [00:16:09]:

Yeah. The expectations are not fairly painted, and a lot of it is that people feel so much better after they have an hysterectomy. Most people choosing to have an hysterectomy, it's not a decision they're taking lightly. They're usually going through something excruciating, so they feel enormously better. Their quality of life is often restored 10 times, but they have these little things that they don't realize that they could overcome and make their quality of life even better. So I think we kind of undersell ourselves on what's possible. Like, yes, you might feel so much relief because your fibroids are gone or your endometriosis pain has gotten significantly better from having a hysterectomy. You don't have to also pee your pants.

Dr. Jocelyn Wallace [00:16:50]:

You don't have to have back pain when you're trying to stand for a long time at a concert. Those things, even though they're not as bad as what people experienced before, can get better with better pelvic health. Similarly, with, pain with sex. Some people have such severe pain with endometriosis and and fibroids before hysterectomy that they'd feel enormous, incredibly better. They can actually have sex after surgery, but it might not be as pleasurable as it could as pleasurable as it could be. They might have trouble having an orgasm, and they don't realize that it could get even that much better with a little bit of pelvic work.

Georgie Kovacs [00:17:26]:

Wow. So what would you say is the most surprising symptom that someone may get if they're either not being proactive before the hysterectomy or getting pelvic floor PT after. If maybe you have a long list. I don't know.

Dr. Jocelyn Wallace [00:17:49]:

I I think it's the most got back pain. That's what I see the most. That's something that's 8 80% of human beings in general will encounter back pain at some point in our our lives. So it's very normalized, and that's the the problem that I help people overcome the most often. And that they don't even realize that the public floor could be a component of that, And it could be hard for people to realize how much better it could be because we tend to associate back pain with just being older. And, like, I'm just not able to stand in line for too long. I can't stand up at concerts anymore. I can't dance at weddings.

Dr. Jocelyn Wallace [00:18:25]:

They don't even realize that that could be better than what they are experiencing until someone asks, like until you ask the right questions and dig into, like, how is your back pain impacting you? How often do you feel it? And then they realize that it's become something that is really inhibiting their quality of life, and it doesn't have to be something that they live with. And most women don't even think to turn to pelvic floor therapy when they're experiencing something like that after a hysterectomy. And most women, if they go to their surgeon, especially if they're cleared at 6 weeks, because, typically, people get cleared at 6 weeks. They're told to ease back into exercise, and maybe they don't realize their back is hurting all the time until 12 weeks because now they're getting more and more active, and now they're really back into their life. Now their back is hurting all the time. They go to their surgeon, and and their surgeon tells them it couldn't possibly be related. It must be your BMI, or it must be your your how sedentary you're being, or it must be your footwear. Let me send you for an orthopedic consult and for an MRI and so on and so forth.

Dr. Jocelyn Wallace [00:19:26]:

And now they're spiraling through the medical system. When if they could have just had proactive care in the beginning, they might not have ever had to have gone through that experience.

Georgie Kovacs [00:19:36]:

It's it's so unbelievably irritating. So I guess I feel like I have to now let's do a summary in the reverse, which is, okay, everyone. Here are the things that are not normal. Okay? Heavy bleeding, like you're changing your tampon all the time, not normal. Period pain, not normal. Peeing in your pants, not normal. Well, and I say this, like, I I remember when I was a a little girl, my, friend would, make they would make fun of her mom because they were like, oh, yeah. When she'd be at the grocery store sneezing, she would always have to, like, cross her legs so she wouldn't pee.

Georgie Kovacs [00:20:11]:

And we would all giggle. And it's like, no. That's okay. Maybe it's a funny story, but no. Again, not normal. Pain and sex, not normal. Lower back pain, constantly Like, anything else that you're Mhmm. Hearing people come in and normalize? Yeah.

Georgie Kovacs [00:20:23]:

Pelvic pressure or feeling heaviness or, like, your insides are

Dr. Jocelyn Wallace [00:20:25]:

sloshing around is one that I hear a heaviness or, like, your insides are sloshing around is one that I hear a lot after hysterectomies.

Georgie Kovacs [00:20:33]:

K.

Dr. Jocelyn Wallace [00:20:34]:

And then chronic abdominal pain and swelling or feeling like after surgery, your stomach just looks vastly different or is really loose or feels like it's constantly bloating and swelling back and forth?

Georgie Kovacs [00:20:45]:

It's almost as if anything below your rib cage between your rib cage and, and your vulva, If anything is changing there, it's like go to a pelvic floor PT in addition to whatever else you're doing. Is that a fair statement?

Dr. Jocelyn Wallace [00:21:02]:

Yeah. Yeah. Absolutely. And anytime your abdomen gets cut open, abdominal surgeries are really serious, and they come with risk of all kinds of scar tissue, adhesions, stuff like that. So the hernias is another common complication of of abdominal surgeries in general. So I can't think of a better reason or a more vulnerable place, a more intimate place to be as proactive about as possible.

Georgie Kovacs [00:21:27]:

So you were mentioning about, clinicians saying, oh, after 6 weeks, you can usually go back to your normal life. Like, let's talk about that. From your expertise as a pelvic floor physical therapist, what would you say are activities that women can do versus what they should avoid and any gauges on duration? Because I presume it it's not fair to say a flat out 6 weeks. I presume it depends on the person. So in general, the more severe, the more the longer the surgery, the bigger the incision, the

Dr. Jocelyn Wallace [00:22:00]:

more time someone should add to that 6 week ex expectation, even though most people get cleared around 6 weeks, even if they have 2 wildly different situations. Like, one person might be having that simple hysterectomy as part of a gender transition. Another person might have had a 20 centimeter fibroid. They've been living in a body that's felt 6 months pregnant for 10 years. They're 2 wildly different situations. They'll probably both be cleared around the same time, assuming their incisions are healed. That's where that 6 week clearance comes from. If your incision is healed, it's unlikely you're going to encounter any life threatening complications,

Georgie Kovacs [00:22:37]:

but it

Dr. Jocelyn Wallace [00:22:37]:

doesn't mean that you're gonna feel amazing as when you start exercising again. I think women deserve to feel amazing when they're moving and living their lives. So I use 4 main yellow flag symptoms, that lower back pain, feelings of pelvic pressure or my insides are sloshing around, incontinence or leaking of any kind. So leaking urine by far most common, but also leaking stool or gas when you don't mean to, and then abdominal pain or chronic swelling or swelly belly. If you're having those things with the activity that you're attempting to do after being cleared, you either need to dial back from that activity and try something differently, or there's something going on from an intensity or form perspective. So an example of that might be, let's say, a woman loves Pilates, and she's getting back to Pilates once she's cleared. And every time she tries a certain exercise, she feels like she pees a little bit. What's probably happening is she's bearing down on her pelvic floor and pushing pressure down on her bladder because that exercise is a little bit too hard for her.

Dr. Jocelyn Wallace [00:23:40]:

So it doesn't mean that she needs to stop exercising. It means that she just needs to modify accordingly so that leaking isn't happening so she can build up the strength necessary to then keep up with the class or whatever it is that she needs to do, which is why I call those yellow flags because it doesn't mean stop. It just means look at the factors surrounding whatever it is you're trying to do and alter so you can keep going without continuing to recreate those symptoms. Typically, at 6 weeks, people the the average person is not going to be ready for hard, like, typical core exercise, so planks, sit ups, mountain climbers, a lot of yoga poses where you're putting your hands and feet through the floor. Most people aren't actually ready for that at 6 weeks. Most people are not ready for running or impact activities at 6 weeks. It typically takes more like 12 weeks for your average person to be ready for those harder activities, assuming that around 6 weeks, they're starting their rehabilitation and, like, listening to these yellow flags as they work through it.

Georgie Kovacs [00:24:40]:

Okay. That makes sense. No. I think back when, just even pregnancy, I had a vaginal delivery, and I remember trying to run after 6 weeks. I'm like, seriously? Yeah. I think I ran down the block, and and I was like, yeah. That this is gonna take a while.

Dr. Jocelyn Wallace [00:24:57]:

Yeah. And all people are told to look out for is just pain, and it's Right. Pain is the last alarm from our bodies. You don't wanna wait for pain. You wanna wait for pressure. You wanna listen to that feeling of things washing around or that peeing feeling or getting swollen after even if it doesn't hurt. And when I talk about lower back pain, I'm talking about that, like, pressure fatigue sort of sensation that people can get running too early, for example. A lot of women have been through so much, they wouldn't even call that pain.

Dr. Jocelyn Wallace [00:25:28]:

So it's not even just that. It it doesn't have to be pain as you define it, but if you're feeling that, like like, someone's standing on your back while you're trying to run or do a plank, for example, like, there's this pressure, there's heaviness, your muscles probably aren't ready for the thing that you're trying to do.

Georgie Kovacs [00:25:44]:

Oh, I like that you described it that way because I would have also thought, like, oh, I was doing my, some of my Pilates exercises incorrectly, and that's why my back's hurting type of pain. I would not have Mhmm. Have described it that way. What about long term after the hysterectomy? Well, I guess, are what other long term complications? Are there any other things that we need to discuss, or have you covered all of that? Because then I wanna talk about long term care for the body.

Dr. Jocelyn Wallace [00:26:10]:

The the thing that kind of hits people years after is prolapse. So a lot of these yellow flag symptoms that I'm talking about, catching those early and not pushing through them can be the key for helping to avoid prolapse, as well as getting the correct and the the best menopausal care depending on how your hysterectomy is lining up with what time of life you're in. So going through menopause increases the risk for prolapse. A lot of people that have hysterectomies are also going through mental health challenges, which can decrease their overall activity level. When you become more sedentary, that increases your risk for prolapse. So looking at the person's overall life picture and making sure that they're getting treatment at the highest standard of care can help to reduce the risk for that long term. And then prolapse is much more preventable if you catch the symptoms early, and those yellow flag symptoms are the they're the early symptoms, pressure, lower back pain. I call the lower back pain pattern that people will have thong distributions.

Dr. Jocelyn Wallace [00:27:08]:

So if you imagine where a thong lays on the body, it'll be that, like, low low tailbone across the top of the glutes kind of area of discomfort. Catching that stuff earlier leads to much better outcomes for long term.

Georgie Kovacs [00:27:22]:

Right. And for those who may not know what prolapses, can you just define that?

Dr. Jocelyn Wallace [00:27:26]:

Yeah. So prolapse is the loss of support of the pelvic organs. So the the organs in the pelvis start to descend and put pressure onto either the vagina or the rectum or both. So people will feel pressure vaginally, lower back pain, things like that. So most often after hysterectomy, it's the bladder pushing down vaginally.

Georgie Kovacs [00:27:44]:

For those who may be listening who are like, oh my gosh. It's been so long since my hysterectomy. I'm feeling awful. I think I've got prolapse. You know, I would I would presume it's not too late for them. Maybe you can share some I don't know if you have a case study or anything wise words, to share with women who are a little bit past the hysterectomy who may not have had this knowledge, early on.

Dr. Jocelyn Wallace [00:28:05]:

Yeah. Absolutely. It's absolutely never too late. There's so much that we can do to help to reverse the symptoms of prolapse without surgery or anything whenever you catch it. It could be 10 years, 20 years after your surgery. If you've done nothing to help fix the the symptoms that you're having, there's an endless toolbox of things that you can try, and I have seen people drastically improve their quality of life after years of struggling with everything that I listed all at the same time.

Georgie Kovacs [00:28:35]:

Okay. Now what about long term care for the pelvic floor? Because, you know, with hysterectomy, like, I don't know, because I know you're focused on pelvic floor physical therapy, but I know that a lot of the urologists and sexual medicine specialists are all about, taking vaginal estrogen for, genitourinary syndrome of menopause. Because hysterectomy puts you in menopause. I know that's been a strong recommendation. But, so I don't know if you have those we should be doing long term to stay, protected?

Dr. Jocelyn Wallace [00:29:16]:

Yeah. Absolutely. Treating your hormonal symptoms, and the OBGYNs I work with the most closely are the, like, the ones that are at the the top of their game, most up to date. They are prescribing vaginal estrogen. So all women at the age of 50 is becoming the standard, and it does help a lot of the people that I work with a lot. It's not a miracle, like you said, but it creates a better environment for your hard work to actually work. They it's a both

Georgie Kovacs [00:29:42]:

I like that.

Dr. Jocelyn Wallace [00:29:44]:

They work together. The things that we can do that are within our control to help prevent these issues or prevent them from getting worse, keeping everything surrounding your pelvic floor strong. So pelvic floor therapy is just the beginning, and my specialty in the people that I work with is bridging them all the way back to actual exercise. Not that pelvic floor therapy isn't real exercise, but getting them fully back to that Pilates class or fully back to their weight training or their running, whatever their thing is, getting them fully back to it in a way that helps to support their long term health, which for most people looks like implementing a regular lifelong strength training program, emphasizing our core muscles, our glutes, our inner thighs, all of the muscles that help to support the pelvis, and repeating that 2 to 3 times a week for the rest of someone's life is the most powerful thing that we can do to prevent issues, and if we already have issues, to help slow down the progression. Because as we lose estrogen, as we lose muscle mass, as we go through life, we do lose support of our pelvic floor structures. We do lose some integrity of the muscle through the ligaments down there, and hysterectomy or not, it gets more likely that we'll have incontinence and prolapse as we get older. The most powerful thing that we can do to prevent that is keep as much muscle and strength on our bodies as we possibly can. And I think that bridge is where pelvic floor therapy often, it stops too soon.

Dr. Jocelyn Wallace [00:31:14]:

It doesn't get people all the way there to where they have a really clear understanding of what they can do for themselves long term to help keep their body strong in that way.

Georgie Kovacs [00:31:25]:

And you did say get an assessment, with a pelvic floor physical therapist beforehand. Correct? And then you have the hysterectomy, and then working through after up until they get into the regular exercise program. And you're right. It does fit because now you have to think after the hysterectomy because they're in menopause. You have to now take into effect all the things that women in menopause need to be doing, which, by the way, we're still now relearning because the women's health initiative study for those who are following all the Fempower Health menopause content or anything else on social media, etcetera, a lot of things are being debunked now. So it's such an interesting world we're in with women's health. It's like we're better understanding menopause, pelvic floor physical therapy, and they're all, like, really tying so nicely to each other. So, what are you seeing day to day as far as the awareness levels of patients and even your, and even those you collaborate with?

Dr. Jocelyn Wallace [00:32:23]:

Yeah. It's definitely improving. Absolutely. It's improved so much that this is all I do now. So I only work with people who have recently or are about to have hysterectomies, myomectomies, or endo excisions. But by and large, it's hysterectomies. Probably 75% of the people that I work with are people that have had hysterectomies. So it's getting common enough that I stay busy, but I am only one person and half a 1000000 hysterectomies are performed in the United States every year alone.

Dr. Jocelyn Wallace [00:32:54]:

So it's certainly not common enough yet.

Georgie Kovacs [00:32:57]:

Anything else that you want to share? Maybe there's a question I didn't ask, or just something general that you want people to be aware of.

Dr. Jocelyn Wallace [00:33:06]:

I would like to clarify that when you do have a hysterectomy, if you're maintaining your ovaries, if you're keeping them, you don't necessarily go into immediate menopause. A lot of people do experience where the ovaries slow down early. So perimenopause can kick off much earlier than expected, sometimes in people's early to mid thirties when they're having hysterectomies that young. That can also happen to people that haven't had hysterectomy. But having hysterectomy and maintaining the ovary still increases the risk of early menopausal symptoms, and getting treatment for that earlier also improves long term outcomes. And too many people are being told, like, oh, you're too young. You're only 40. You're too young to be going through perimenopause, and that is simply not true.

Dr. Jocelyn Wallace [00:33:51]:

And the cascade like, when people have an hysterectomy, they're so afraid of prolapse and incontinence and dementia and cardiovascular decline and all these things you'll see on Google when you Google hysterectomy. Those risks are so much higher for women who have untreated perimenopausal symptoms, and it needs to be taken very seriously when people are having those kinds of symptoms, especially mental health types of symptoms. They need to get their hormones treated by a, up to date doctor so that they can get back to their lives sooner and get moving sooner and stay active and stay engaged in their lives. So if I could tell people one thing, it's, like, if you feel like you're experiencing something that's not normal in your body, even if you're young, even if people have told you that it can't possibly be related to your hormones, which is the surgery you had 6 or 12 months ago, keep advocating. Find a doctor that stays up to date with menopause care. They'll usually call themselves NAMS or North American Menopause Associated Society, certified menopause specialists. Find someone like that. And don't forget about telehealth.

Dr. Jocelyn Wallace [00:34:57]:

You don't have to live in your locality anymore. You could there's so many resources out there to get access to the best doctors even if they're outside of your state or your country.

Georgie Kovacs [00:35:09]:

Even if someone didn't have a partial hysterectomy, some doctors still say forties is too early for perimenopause. I'm like, oh my god.

Dr. Jocelyn Wallace [00:35:16]:

I was just gonna say, yes, it can happen in your forties, and the impacts of 10 years of not having that treated is so much worse than the impacts of having hysterectomy. That's the scary thing.

Georgie Kovacs [00:35:26]:

I know. I know. Well, I really appreciate that you reached out. This is definitely an episode I never would have thought of, but makes 100% sense. And so I'm really, really glad we had this conversation.

Dr. Jocelyn Wallace [00:35:37]:

Yeah. Absolutely. So I'm the most active on Instagram. My handle is doctor Jocelyn Wallace. My website's the same.com. And then if you this was a lot of information that we covered. It's been feeling overwhelming. The most valuable thing that I would point people to first is I have a questionnaire that you can download, on my Instagram links that is a a list of different pelvic floor symptoms that you could just circle or mark the ones that you resonate with, take it to your doctor, and then you have the language to communicate about this stuff, which is the first step is just knowing what's normal, what's not, and having the language to start asking for help.

Georgie Kovacs [00:36:13]:

Awesome. Thank you again for your time and for your expertise. Really, really appreciate it, and, I can't wait to share this episode.

Dr. Jocelyn Wallace [00:36:20]:

Absolutely. Thank you so much for having me. It's a great time. Thank you for allowing me to share my message.