How to Improve Your Pelvic Floor for Better Health with Alicia-Jeffrey

How to Improve Your Pelvic Floor for Better Health with Alicia-Jeffrey Thomas [Episode #989]

This Week’s Episode:

In this episode Kimberly interviews Alicia Jeffrey Thomas, a doctor of physical therapy, about the importance of pelvic health. They discuss the anatomy and function of the pelvic floor, factors that can weaken it, and how it relates to digestive and urinary health. Alicia shares insights on the interconnectedness of body systems, the impact of stress and trauma, and practical exercises for strengthening the pelvic floor. They also touch on the significance of pelvic health during pregnancy and the challenges faced by women experiencing painful sex due to hormonal changes. The conversation continues with the complexities of pelvic floor health, the role of posture and breathing, and the emotional aspects tied to pelvic therapy. They explore the significance of building trust with practitioners, and the interconnectedness of body mechanics. The discussion emphasizes the need for open conversations about pelvic health and the empowerment that comes from understanding one’s body.

About Alicia-Jeffrey Thomas

Dr. Alicia Jeffrey Thomas has been a pelvic floor physical therapist since 2016 and treats people of all genders in the greater Boston area. She isn’t one to shy away from taboo topics. From bladder problems to bowel movements to sex, Alicia is always game to talk through the dirty details to help patients figure out what’s going on “down there.” To this end, she has created and directed multiple social media channels where she spreads evidence-based pelvic health information in humorous and relatable ways. Her page, @thepelvicdancefloor, has over 1.2 million combined followers, between Instagram and TikTok. She and her content have been featured in podcasts, magazines and blogs, and on television. Although born and raised in Florida, she now lives in Boston with her husband and their dog.

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Guest Resources

Book: Power to the Pelvis: Improve Your Pelvic Floor for Better Digestive, Urinary, Reproductive and Sexual Health

Website https://www.thepelvicdancefloor.com

Episode Chapters

00:00 Introduction to Pelvic Health
02:05 Factors Affecting Pelvic Floor Health
04:51 The Interconnectedness of Body Systems
05:56 The Role of Trauma and Stress
06:21 Pelvic Floor and Digestive Health
08:28 Personal Experiences with Pelvic Health
09:36 Common Bladder Issues
11:22 Time Commitment for Pelvic Floor Exercises
13:00 Effective Pelvic Floor Exercises
15:26 Preventive Care for Pelvic Health
16:14 Pelvic Health During Pregnancy
18:20 Painful Sex and Hormonal Changes
20:12 Understanding Pelvic Floor Challenges
22:23 The Importance of Posture and Breathing
24:43 Connecting Breath with Pelvic Health
27:13 Addressing Trauma and Sensitivity
30:12 Preventative Care During Pregnancy
31:40 Navigating Vulnerability in Therapy
33:18 The Interconnectedness of Body Mechanics
35:00 Empowering Conversations Around Pelvic Health

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Transcript:

Kimberly Snyder (00:00.526)
Hi loves and welcome back to our Monday interview show. I am so excited for our very special guest here with us today. Her name is Alicia Jeffrey Thomas. She is a doctor of physical therapy and a certified pelvic rehabilitation practitioner. She has a brand new book out called Power to the Pelvis, improve your pelvic floor for better digestive, urinary, reproductive and sexual health.

Alicia, thank you so much for being here with us today.

Alicia Jeffrey-Thomas (00:30.621)
Thank you so much for having me.

Kimberly Snyder (00:32.622)
It’s a really interesting topic. think a lot of us have heard about our pelvic floors. We’re always looking for new ways, especially when you’re talking about digestive health, which is such a big thing in our community, but also all these other aspects. Before we dive in, what is, I know this sounds really basic, but what is the pelvic floor? Because some of us are imagining the bones, but then you talk a lot in your book about muscles. So can we just give sort of a broad definition?

Alicia Jeffrey-Thomas (01:00.497)
Yeah. So, okay. So you think about the bones, right, you have your pelvis, there’s a hammock of muscles that run from the pubic bone in the front, all the way up and underneath to the tailbone in the back. So it basically is responsible for holding up your internal organs. So your bladder, your bowel, your, I mean, sort of kind of your uterus, right? And then, you know, opening and closing for those functions to be able to go to the bathroom, to be able to, you know,

have a child, be able to have sex, all of these ins and outs there. And then it also works with your core for core stability. It works as a stabilizing function there. So it’s this small set of muscles, relatively speaking, that we don’t see, so we don’t really think about, but it plays a big role in a lot of really integral parts in the body.

Kimberly Snyder (01:48.96)
And why might our pelvic floor be thrown off, especially in modern life? I know we’re sitting more, or what are some of the factors why, of course, having a baby, but what other reasons might our pelvic floor weaken and we don’t even realize what’s going on?

Alicia Jeffrey-Thomas (02:05.863)
Yeah, I mean, I think, you know, a big factor for a lot of people can be stress. you know, in, the same way that when you’re stressed, find yourself clenching your jaw or like, you know, squeezing your glutes, your pelvic floor is probably also kind of tensing up as a result. so for some people that can result in, you know, pelvic pain, which could be pain with sitting, it could be, you know, just pain with, you know, any kind of, like sexual activity or, exams or anything like that.

Kimberly Snyder (02:10.562)
Mm.

Kimberly Snyder (02:26.094)
Mm.

Alicia Jeffrey-Thomas (02:36.166)
It could be that pelvic floor issues could develop from repetitive bathroom habits that maybe aren’t the best. So people who strain to go to the bathroom a lot, they could develop like a prolapse or a weakening of the pelvic floor or different things that would kind of fall under that umbrella. There are tons of different little lifestyle factors that we don’t really even think about that over time doing things.

on a consistent basis can have those stacking negative effects.

Kimberly Snyder (03:09.27)
What about not breathing properly?

Alicia Jeffrey-Thomas (03:12.201)
my gosh, that’s a huge one. Yeah. mean, and that kind of comes into it. Yeah. Yeah. I mean, a lot of it, you know, if we, if we think about how we grew up, right, a lot of us were kind of told like suck it in, you know, try to look smaller, look skinnier. we’re constantly like pulling in a little bit. that over time is kind of changing your breathing patterns because if you’re not kind of having this full expansive breath happening,

Kimberly Snyder (03:14.574)
You’re not really taking your breaths.

Alicia Jeffrey-Thomas (03:37.969)
then your muscles are having to do weird things to compensate. They’re tensing up or weakening in different ways. And that can also have kind of a nervous system-wide effect. So it’s harder to get out of that fight or flight if we’re not able to take like really good deep breaths.

Kimberly Snyder (03:56.366)
Yeah. And what about, I’ve heard, you know, with fascia, Alicia, or fascia, that there’s a piece of fascia that’s connected to your jaw that runs all the way down. So let’s say you’re clenching in your mouth, which is something I used to do a lot. I used to be a mouth or a teeth grinder. And can that, I know it can affect your back. It’s also affect your pelvic floor. It’s all interconnected.

Alicia Jeffrey-Thomas (04:05.49)
Mm-hmm.

Alicia Jeffrey-Thomas (04:12.079)
Yeah.

Alicia Jeffrey-Thomas (04:15.837)
Mm-hmm.

Alicia Jeffrey-Thomas (04:19.315)
Right. There’s that whole frontal fascial plane that’s going to run all the way down like to like the front of the pelvis. And so, you know, we, we see that a lot, like people who have, you know, tension through here or, or, you know, gripping through their masseter muscle. we do release work here, we notice a change in their pelvic floor or vice versa. I’m working on somebody’s pelvic floor and they tell me, you know, I didn’t mention this before, but I’ve had jaw pain for a while. My jaw’s actually been feeling a lot better since we started doing this relaxation work for the pelvic floor. So there’s, there’s these kind of cool little.

Kimberly Snyder (04:36.174)
Yeah.

Kimberly Snyder (04:43.758)
Mmm.

Alicia Jeffrey-Thomas (04:48.847)
related effects that we can get. Little side quests.

Kimberly Snyder (04:51.234)
Well, I love how everything’s so related. And here we talk about really holistic approach with food and your body, your physical body and your emotions and also your spiritual growth. So one of the things you talk about in the book is trauma. You also talk about tension and stress. And from a yogic standpoint, this pelvic floor area is the Mooladhara chakra where we can hold fear. And when it’s balanced, we can feel more safe and secure, which is directly linked to our abundance.

Alicia Jeffrey-Thomas (05:18.397)
Yeah.

Kimberly Snyder (05:18.882)
There’s a lot that can happen energetically from feeling literally more rooted and more healthy down in that area.

Alicia Jeffrey-Thomas (05:26.609)
No, absolutely. And that totally makes sense with what I see clinically. I mean, if we’re holding a lot of tension, that creates this stress cycle that happens, like stress to tension cycle. so particularly, if we aren’t comfortable with moving that area of the body or talking about that area of the body, then it becomes this thing that we put into a little box. And so part of what I really love about working in pelvic floor therapy is giving people

Kimberly Snyder (05:30.862)
Mm-hmm.

Alicia Jeffrey-Thomas (05:56.477)
that freedom to be curious and explore and bring awareness to these areas.

Kimberly Snyder (06:03.438)
So I love how you, going back to the digestive health, which you lead in your subtitle, there’s many reasons our digestion can be off. Of course, what we’re eating, we’re not eating fiber, we’re eating a lot of junk food, we’re eating a lot of sugar, so on and so forth. Tell us how realigning your pelvic floor can optimize digestion as well.

Alicia Jeffrey-Thomas (06:21.361)
Yeah. So from the most simplistic standpoint, your pelvic floor is the last part of that whole system, right? That starts at your mouth when you take something into your body. so, you know, one of the ways that we can define constipation can be that the muscles there don’t do a good job kind of getting out of the way to allowing things to evacuate completely. So working on that ability to relax so that you’re not having to strain is going to result in

Kimberly Snyder (06:42.945)
and

Alicia Jeffrey-Thomas (06:51.335)
more complete elimination, which then can kind of cascade into other things, right? So if you’re more backed up, that can actually put pressure on your bladder and contribute to bladder symptoms. So there’s kind of those effects, but then also, thinking up the chain a little bit more, your pelvic floor is very, very related to your abdominal wall and things like that. And so if we work on kind of mobility of the abdominal fascia and things like that, that can also help to promote more gut motility.

so that things are moving through the system at a normal pace and not getting stuck somewhere along the path.

Kimberly Snyder (07:26.786)
Well, I love your pictures in the book and there’s a picture in here of you sitting on a toilet with a little stool. And so there’s all these tips and hacks we can incorporate. And there’s also the exercises, which we’ll talk about in a moment, but also this lifting of your, or lining your knees can actually help you have more thorough bowel movements.

Alicia Jeffrey-Thomas (07:33.0)
Yeah.

Alicia Jeffrey-Thomas (07:38.973)
Totally.

Alicia Jeffrey-Thomas (07:42.578)
Mm-hmm.

Alicia Jeffrey-Thomas (07:46.107)
Yeah. So basically when you sit with your feet just flat on the floor, your pelvic floor kind of kinks around your large intestine. So instead of having, you know, a nice easy path, it kind of has to make an extra turn before everything comes out. if you elevate your feet so that your knees are a little bit higher than your hips, then all of a sudden that pelvic floor can relax. And so then your colon straightens out and you have a much more straightforward path to the exit.

Kimberly Snyder (08:10.594)
Leisha, on a personal note, did you struggle with bathroom problems or pelvic floor problems? I’m always interested how, I know in my line of work, you I write about the things that I’ve worked on myself and struggle with. So it’s really interesting that this is where your career, where your work focus has led you.

Alicia Jeffrey-Thomas (08:27.507)
It’s really interesting because before I’d been in the field for a couple of years, I wouldn’t have made that connection. It’s something that I kind of buried, right? But I realized, yeah, I was a really constipated kid. I joke all the time that my mom should have been the person to patent the squatty potty because she was the person that was always saying, just turn the trash can on its side, put your feet on top of that and stuff like that to help me. But there’s little things that I think what drew me to the field was realizing that

Kimberly Snyder (08:49.614)
Mm.

Alicia Jeffrey-Thomas (08:55.539)
I had these little internal conversations with myself that once I started seeing them play out in a clinical setting, I realized just how many people were not having these conversations because they didn’t have the language, because they didn’t feel comfortable, because they were embarrassed, whatever it was. And so that was just an opportunity to really give people their voice and to have them be able to take a little bit of that power and quality of life back.

Kimberly Snyder (09:19.084)
Yeah. You also talk about the bladder and sometimes again, this isn’t something that’s widely talked about. We think about, maybe when you’re, you know, older, seventies, eighties, nineties, you may have bladder issues. How common is it for women or people of all ages to sort of struggle?

Alicia Jeffrey-Thomas (09:36.527)
It, yeah, mean, you know, the statistics are super variable. mean, it’s kind of like, you know, urinary incontinence can be upwards of like, I think like one in three people. Yeah, can struggle with it. And I think to a certain degree, like everybody can kind of recall a moment that they almost had a problem, right? And it’s whether that then turns into something that

Kimberly Snyder (09:49.112)
Really?

Alicia Jeffrey-Thomas (10:04.807)
pushes over the edge to where, okay, I leaked a little bit when I coughed that time, but maybe that won’t happen again. And maybe we try to like, you know, hold off and say, okay, no, that was just a, that was a fluke. And then it happens a second time and you’re like, okay. And so whether that then becomes something that you report to your physician to try to get help for is, you know, I think a lot of these statistics could be a lot more common than we give them credit for because people are so afraid to bring this up.

Kimberly Snyder (10:30.293)
Yeah.

Alicia Jeffrey-Thomas (10:33.691)
It’s very common, but it doesn’t have to be your normal. You can have leakage with coughing, laughing, sneezing, running, jumping, that all kind of falls under stress incontinence. And it happens to people regardless of whether they’ve had children. It happens to people at any age. mean, you see elite athletes, gymnasts and people who do a lot of impact work that are starting to talk about their struggles with urinary incontinence.

all the way up to your older generation, post-menopausal, where we’re having weakening of the pelvic floor and decreased supporting structures and things like that. So it’s a conversation that I think we need to be comfortable with so that we can get the help that we need.

Kimberly Snyder (11:12.674)
Well, so, and you break this down by different topics and there’s different exercises. If someone’s listening to this or watching this and they say, hey, I do have a bladder issue that I want to address or digestive issue. How much time on average, and I know this is very individual, but how much time does one have to devote to these pelvic floor exercises on a regular basis?

Alicia Jeffrey-Thomas (11:22.835)
Yeah.

Alicia Jeffrey-Thomas (11:33.959)
Yeah, no, that is a really good question. you know, I try to make it when I’m developing a home exercise program for a patient, I don’t want it to be something that feels like it’s so overwhelming to their life. Like if I can give you bite sized things that like maybe you’re doing a couple of times a day that I’m going to try to do that versus saying, here’s an hour’s worth of exercises that you need to do. Right. We’re so busy and that’s just going to increase your stress level. And it’s kind of like, you know, there’s a

Kimberly Snyder (11:55.15)
We’re all so busy, you know.

Alicia Jeffrey-Thomas (12:02.013)
There’s a level at which somebody says, if I can’t do all 10 of these things, then I’m not just going to, I’m just not going to do any of them instead of maybe I’ll do three. And so if I set it as here’s a little module that you can do, right? Of like two or three things. And if we try to incorporate those, you know, when you take a break at work or right before you go to sleep, like little things that are easier to integrate into your life. I tend to see that working better for people. but again, it’s, all going to be individualized to what that person.

Kimberly Snyder (12:08.974)
Great.

Kimberly Snyder (12:26.007)
Yes.

Alicia Jeffrey-Thomas (12:30.397)
feels like they can commit and maybe that changes the amount of time that they’re working on this for, know, different things like that.

Kimberly Snyder (12:37.026)
Can you give an example of a general pelvic floor exercise that might be great for, I know it’s individual, but someone who’s just looking to strengthen their pelvic floor in general, like a simple exercise so someone can get an idea of what it feels like. I know there’s a chapter in your book where you talk about going beyond key goals, which is what most of us hear about with exercises in this area.

Alicia Jeffrey-Thomas (13:00.091)
Yeah. So, so right. So a Kegel is a contraction of the pelvic floor and it’s just that very isolated activation of the pelvic floor, which is great to know how to do, but it doesn’t translate to function. I want to know more about what the pelvic floor is doing when you’re doing a squat or a deadlift or a bridge or something like that. So if we take a bridge, for example, right, because this is one that most people can do. so you’re lying on your back with your knees bent and you’re trying to like squeeze your glutes to lift your hips up.

I want you to be able to kind of get in tune with what your pelvic floor is doing. When you lift up, do you find that you’re holding your breath, right? Which might be putting pressure downward onto your pelvic floor. Then I’m trying to tell somebody, okay, maybe we’re exhaling as we do that. What’s happening with the position of your spine to make sure that you’re not like overly flattening your back, but also that you don’t have some big arch in your back. That’s also kind of throwing off the whole mechanics of the system. And whether we then additionally cue for contracting the pelvic floor as you do that.

depends on what’s happening with the person because a lot of times these motor patterns are happening automatically where if I have you do certain movements, your pelvic floor is going to protectively to say, okay, yep, we need to make sure we support the organs when you’re doing this more loaded exercise. So it’s layering in all of those pieces so that you’re not having to kegel, do the thing, relax kegel. That’s not how I want it to have to function in the long term.

Kimberly Snyder (14:24.93)
got it. So it’s not as simple as, do 10 Kegels while you’re driving your car and you can work it into your day while you’re sitting there with your clothes. It’s more nuanced is what I’m hearing you say.

Alicia Jeffrey-Thomas (14:29.434)
No.

Alicia Jeffrey-Thomas (14:36.755)
Totally. The Kegel thing, it’s great because it’s an exercise that is really accessible. It doesn’t require any equipment. You can kind of do it anywhere. But it’s like medication, right? We want to make sure that we have the right medication at the right dosage at the right time for the right person. We talk about exercise as medicine, and this is one of those instances where I’m like, okay, well, not everybody needs to be taking the Kegel medicine.

Kimberly Snyder (15:05.772)
Right. Well, let’s say someone is going to the bathroom pretty well and they don’t have bladder issues. Are these signs that we have a healthy pelvic floor? And in that case, do we still need to do pelvic exercises sort of preventively for the future? Or is this more like you feel that there’s an issue and you want to explore it deeper?

Alicia Jeffrey-Thomas (15:26.227)
So, I I am never going to tell somebody like, just forget about your pelvic floor, right? Like I think it needs to be something that we need to be, you know, aware of and have knowledge of. And so in an ideal world, what I would encourage people to do is to get their pelvic floor muscles assessed by a professional who can say, you know, yes, you’re not feeling XYZ symptoms, but

Kimberly Snyder (15:37.923)
Right.

Alicia Jeffrey-Thomas (15:49.489)
I noticed that when you do this, you are bearing down or that you’re doing something you’re not supposed to. So like, here’s a couple of things that you can individually work on, right? But it’s in, in an asymptomatic person, it’s, it’s going to be like particularly nuanced because I don’t want to have them then like kegel themselves into a pelvic floor issue, you know, where then their muscles get too tense and then they start having issues, you know, relaxing to like go to go to the bathroom or something like that.

Kimberly Snyder (16:08.205)
Right.

Kimberly Snyder (16:14.51)
Well, and when there’s a life changing circumstance, let’s say pregnancy. So let’s break it down, Alicia, pre, during, post, because I love you talk about reproductive health. How can healthy pelvic floor even help potentially with fertility?

Alicia Jeffrey-Thomas (16:18.545)
Mm-hmm. Yeah. Yep.

Alicia Jeffrey-Thomas (16:30.547)
No, definitely. In the earlier stages, so pre-pregnancy, the vast majority of people are not going to have a pelvic floor issue unless they have that pelvic floor tension. Usually we’re seeing frequent urination or pain with sex or something like that. Once you are pregnant, you can do strengthening and awareness training for your pelvic floor because you’re going to

Kimberly Snyder (16:59.16)
while you’re pregnant.

Alicia Jeffrey-Thomas (17:00.081)
while you’re pregnant in the earlier trimesters, right? So, because as the pregnancy is growing, we’re getting more load placed on top of the pelvic floor. So it’s almost kind of like you’re like strapping more and more dumbbells to the pelvic floor muscles. And so training that and having that awareness can be really good for reducing urinary incontinence in pregnancy to decreasing back pain, you know, especially if we’re incorporating it alongside other, you know, core exercises and

body awareness, postural training, things like that. Once we get into the later stages of pregnancy and we’re getting closer to delivery, then we start thinking about the opposite end of the spectrum where we say, okay, the pelvic floor needs to be able to get out of the way for that baby to come out because the pelvic floor doesn’t push the baby out, the uterus does that. But if you’re always clenching the pelvic floor and we’ve only been working on strengthening, then sometimes it doesn’t necessarily have that like…

ability to let go on its own, and especially to be able to keep the pelvic floor relaxed through something as painful as labor or a contraction or whatever. And so we do that kind of training. do, know, perineal stretching training, labor positioning training, things like that.

Kimberly Snyder (18:07.392)
If someone’s clenching though, let’s say sex is painful, is there any way that could, and I’m just asking, really don’t know, but prevent, let’s say the sperm from going all the way, actually prevent pregnancy, is that possible?

Alicia Jeffrey-Thomas (18:13.787)
Mm-hmm. Yeah.

Alicia Jeffrey-Thomas (18:20.603)
No, I wouldn’t say that. As long as penetration is possible, then that’s not going to be the inhibiting factor. There are people who have a condition like vaginismus, for example, where the pelvic floor muscles are so tense that nothing can go in. There are people who can’t even get a Q-tip in or have a speculum exam or something like that. so there are people who work with…

Kimberly Snyder (18:25.559)
Okay.

Kimberly Snyder (18:30.38)
Okay.

Kimberly Snyder (18:42.669)
What?

Alicia Jeffrey-Thomas (18:47.313)
reproductive endocrinologists who will do artificial insemination because they’re not able to achieve it that way. But from a pelvic floor perspective, it’s not necessarily going to interfere with insemination otherwise.

Kimbe

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