0:00:04.6 Kim Schlag: Welcome to Episode 89 of the Fitness Simplified podcast. I'm your host, Kim Schlag. On today's episode I am joined by physical therapist, Marci Silverberg, who specializes in women's health and pelvic physical therapy. We chat all about diastasis recti, what you need to know about it, even if, listen to this ladies, even if it's been years and years since your last pregnancy. Let's go. Hi there Marci.
0:00:32.5 Marci Silverberg: Hi Kim.
0:00:32.6 Kim Schlag: Welcome to the podcast.
0:00:34.2 Marci Silverberg: Thank you so much.
0:00:35.5 Kim Schlag: I'm so glad you could join me here today. We are gonna be talking about pelvic floor physical therapy, but before we do, I would love to learn a little bit about you. So tell me who you are and where you're from, tell me about you, what you like to do for fun?
0:00:52.4 Marci Silverberg: Sure, sure. Well, I'm located in California. I'm from New York originally, and I have two young kids, and we're in the middle of a pandemic, so I'm pretty busy schooling them [laughter]
0:01:06.2 Kim Schlag: So your hobbies are schooling your kids and taking care of your kids.
0:01:10.2 Marci Silverberg: Well, yeah, I'm getting outside, and we have been blessed to have really good weather. So getting out, going on walks, and then when I have the time, I mean, I'm a huge outdoor enthusiast, we've been going camping a lot actually, since the pandemic. I would say, my hobby is...
0:01:24.2 Kim Schlag: Really?
0:01:26.3 Marci Silverberg: Yeah. Right before the pandemic my husband convinced me to get this little camper van. It's the best decision we ever made, and so we've been doing a lot of camping during the pandemic, and that's been awesome. It's been like saving us.
0:01:39.3 Kim Schlag: So it's a van, but it's a camper?
0:01:42.9 Marci Silverberg: Yeah, it's a little camper, it's called a Scamp, and we tow it, and it's got little beds inside, and the kitchen. Yeah.
0:01:53.3 Kim Schlag: That sounds fantastic.
0:01:55.7 Marci Silverberg: Yeah, it's been really cool.
0:01:56.8 Kim Schlag: And do you guys like to hike while you're camping?
0:02:00.7 Marci Silverberg: Oh yeah, absolutely.
0:02:01.0 Kim Schlag: Nice.
0:02:02.5 Marci Silverberg: Yeah. Hiking, exploring as much as we can.
0:02:06.1 Kim Schlag: And the kids enjoy it?
0:02:07.0 Marci Silverberg: They absolutely love it. And because we're in northern California, there's a lot of places to check out, so it's been fun. Yeah.
0:02:14.5 Kim Schlag: I bet. I bet. Okay, so for those of us who aren't familiar with Northern California, if we come to Northern California and wanna do some kind of outdoorsy, camping, hiking thing, what's the spot we should be sure to hit?
0:02:25.4 Marci Silverberg: We love going to Santa Cruz. That's where we love going, 'cause it's right on the beach and there's camping, but anywhere... All along the coast there's tons of things to do, and then there's the national parks, there's Yosemite, which we've been to. There's tons of places to go.
0:02:41.6 Kim Schlag: Amazing. I've never been to Northern California, ever.
0:02:46.6 Marci Silverberg: Oh my gosh, I highly recommend it.
0:02:48.9 Kim Schlag: Yeah.
0:02:49.9 Marci Silverberg: You should come out.
0:02:50.0 Kim Schlag: One of these days, when we're allowed to travel again someday.
0:02:52.3 Marci Silverberg: Yeah.
0:02:52.4 Kim Schlag: I'll make sure I get there. So Marci, tell me a little bit about exactly what you do as a pelvic health physical therapist?
0:03:00.4 Marci Silverberg: Sure. Well, my background before I became a pelvic health physical therapist, I basically treated the entire body, but just not the area of the pelvis and the pelvic floor, and so now I have this special training where I can also treat this area. So what that means is, you've got your pelvis, and then there's this really important group of muscles at the very base of the pelvis called the pelvic floor muscles, and these muscles, they have a lot of roles for sex and continence, and they're actually part of your core, and they can get affected through the course of a woman, or a man's life, especially around pregnancy and childbirth, and so when there's problems with these muscles that could present as leaking or pain with intercourse, there's a problem called pelvic organ prolapse and just the core is not functioning well. And so I just have specialized training in order to work with these muscles and understand their connections to the rest of the body, and I also treat issues with the uterus and the bladder and the rectum, and all the organs that live inside the pelvis. So I feel it's just maybe better actually treating the entire body, because now instead of treating the whole body and just not this area, I treat that area too, so that's how I see it.
0:04:18.8 Kim Schlag: And how did you decide to get into this particular specialty of physical therapy?
0:04:24.0 Marci Silverberg: Through my own issues, which is how a lot of women tend to get into it. When I was pregnant with my son, so this was now nine years ago, I found myself looking for a physical therapist that specialized in this. Because I had these weird issues where I would wake up in the morning and I couldn't walk, I couldn't put weight on one of my legs, and then it would get better as the day went on.
0:04:48.1 Kim Schlag: Wait, what would happen? If you physically couldn't hold yourself up, or what would happen?
0:04:53.3 Marci Silverberg: Yeah. Intense pain. Like intense pain on one side of my pelvis where this joint is, called the sacroiliac joint. I couldn't understand it, but then I would walk it off, it would kinda go away, which is kind of funny 'cause sometimes pregnancy pains present that way, they kinda come and go. And then it happened again after I had my son, and then I developed this condition called diastasis recti, it's an abdominal separation that can happen sometimes during pregnancy.
0:05:25.6 Kim Schlag: Got it.
0:05:27.4 Marci Silverberg: And so, as a physical therapist I wasn't specialized in how to work with this, but I was very curious about it. And I had all these questions about it like, "What exactly is going on with me and how do I fix it? And why did it happen? And if I have another baby", because I was planning to, "Is it gonna happen to me again?" And so I just started researching and taking classes, and figuring out how to put myself back together again and rehabilitate myself. And then in the process of that I just discovered this specialty field and all the other issues that women have. And I found there's a lot of women like me that are looking for answers and have these issues and don't quite know what to do about it. And I found out that a few of these issues that I treat in addition to diastasis, leaking and everything else, they're actually really common issues that women don't talk about because they feel ashamed about, but then it really affects their quality of life. And so as I learned what to do about it, I just felt more and more impassioned about learning more and directing my practice towards working with women with these issues, which is exactly what I do now.
0:06:39.5 Kim Schlag: So tell us some more about... I always say this word wrong, is it diastasis or... It's diastasis, right?
0:06:47.5 Marci Silverberg: It's either. I've heard it diastasis, or diastasis.
0:06:52.5 Kim Schlag: Diastasis, diastasis. How do you say it?
0:06:54.4 Marci Silverberg: I say diastasis.
0:06:56.7 Kim Schlag: Okay, we're gonna go with diastasis. I can never remember. Diastasis. Okay, diastasis recti. Tell us more about that. What is it? How did you first realize... What were your first symptoms of it? Just tell us, kind of give us a brief overview of it.
0:07:09.7 Marci Silverberg: Yeah, so it's an abdominal separation. And the way I figured out that I had it, is very classic. So what happened was, I was cleared six weeks to start exercising, and I knew I needed to work on my core, 'cause I had these issues before with pain. And so I started just doing some exercises, to say I'm doing a harder exercise, like a plank, and I look down at my belly and I'm like, "What is that? Looks like an alien". It just looked like there was a baguette laying on my stomach, from the top to the bottom, where the skin was kind of pooching out, and I didn't have that before. And you look at it and you're like, "What is that? I did not have that before. What can I do to make that go away?" And then also when I'm getting in and out of bed, you see it. And then so I start doing exercises to try to make it better, and the exercises I was doing at the time weren't helping, but to answer your question, what it is, is the abdominals, they separate a little bit.
0:08:13.1 Marci Silverberg: So a lot of people know that the rectus abdominis, that six-pack muscle. Well, there's this band of tissue in the front of the belly, it goes from right below the ribcage, and then it goes all the way down and connects on the pubic bone, and it's called the linea alba, and it's fascia. And it's meant to stretch during pregnancy, but what happens is, it just gets overly stretched. And then so what that band was that I was looking at or that pooching, was that when I was doing exercises, my body wasn't developing tension. Because that area was thinned and separated abnormally and my body wasn't developing tension there, and so it was kind of like poking out. And so what it looks like is, you feel like you look like you're still pregnant. So what happened to me was I lost my pregnancy weight, but I still had this belly where I look like I was four months pregnant or so.
0:09:05.6 Kim Schlag: Interesting. Now, is it painful?
0:09:08.9 Marci Silverberg: No.
0:09:10.5 Kim Schlag: Not painful. So it's just how it looks. Can you feel it with your hand?
0:09:16.8 Marci Silverberg: Yes, you can feel it with your hand, depending on what you're doing. So when you're doing something challenging to the muscles, that's when it will poke out and you could kinda feel it with your fingers, and that's how you can test to even see if you have it. If you do a little sit up and you see it, or you might even not see it, but you kind of put your fingers in that area and press, then you could feel the edges of the muscle. What you should feel, if you do a little sit up and you press on your tummy, you should feel tension or firmness, like a trampoline. That means that your body is... Not only are your muscles contracting, but along that tissue sheath, your body is developing some appropriate tension there. So when your body doesn't do that, you might see the doming and then you feel the edges of the muscle and like a sinking in, and softness instead of that firmness.
0:10:08.7 Kim Schlag: And is it preventable in any way?
0:10:13.7 Marci Silverberg: That's such a good question. It's normal to a degree. What I discovered is it's actually physiologic and normal process. Research shows that at 35 weeks pregnant literally 100% of women have a diastasis at that point. 'Cause it's normal, when you get pregnant and your muscles stretch, that this sheath does get stretched out. Now by around six weeks postpartum for many women it just will close up on its own, they don't need to do anything specifically to make that happen, just they're the lucky ones. And then there's about 40% of women or so, I've read different numbers, 30%, 40% of women where it just doesn't close up on its own, and then those women would need to do rehab or something else to work on it.
0:11:01.3 Kim Schlag: That's a really high percentage.
0:11:03.0 Marci Silverberg: It is. It is a high percentage.
0:11:05.1 Kim Schlag: I did not know it was that common. Interesting.
0:11:08.9 Marci Silverberg: That's the thing about a lot of these things that I treat. They're surprisingly common.
0:11:14.3 Kim Schlag: Yeah.
0:11:15.2 Marci Silverberg: Yeah.
0:11:16.7 Kim Schlag: And can it be fully healed? Does it get to a point where you had a diastasis and now you do not have it present?
0:11:24.9 Marci Silverberg: It takes a little explanation. You should know that it is normal to have a diastasis to a degree. So it's considered normal to have, like I explained how you could put your fingers in there and you can feel the gap, so up to two and a half finger widths is actually considered normal. And that's a really important point, because I think when women hear about this they can get a little bit obsessive like... And I understand, and I was this way too, wanting it perfect, wanting everything back together. But there is a certain degree of gap that's considered normal, and some women have a gap even before they're pregnant. But most women wouldn't know, 'cause they don't think to test themselves before they're pregnant, to see if there's a gap even in the first place. And so for some women, when you do rehab, it does come back together to a degree, and it varies for different women, how much it comes back together. And I'll also say that the distance of the fingers is actually not even as important as that tension that I mentioned. So, yeah, there's a lot of interesting things about it, as it starts to heal and we focus on developing tension. Research has showed that as the muscles get stronger, there might be more tension, improved tension, yet more gap. So if we focus on healing the gap and getting the muscles to approximate, that's actually not even a good measure of...
0:12:52.0 Kim Schlag: Interesting. So it's the tension that's the main point?
0:12:56.6 Marci Silverberg: Absolutely. Yeah. It's the tension that's the main point. 'Cause that means that the muscles are responding appropriately and you're getting good forced closure in the front of the abdomen. So it's the tension that matters.
0:13:09.5 Kim Schlag: Besides the aesthetic piece of it, like maybe a person just doesn't like how this looks, what are the other problems that come with having one that is too big?
0:13:21.8 Marci Silverberg: So that's another interesting question, because the research about diastasis is actually just coming out, it's not super strong. So the diastasis has been associated with back pain and with pelvic floor dysfunction. And I say associated with it because pelvic PTs, we often talk about that it's important to fix a diastasis because it could be causing back pain, or pelvic floor dysfunction, or other issues, but the research, the evidence, doesn't actually show that, but I definitely see that in practice. So if someone has a diastasis and they're looking to improve it, right? Which we definitely wanna do, you look at the pelvic floor, and a lot of times the pelvic floor is weak too. And so in rehabbing the whole system, we're preventing other issues, or someone with a diastasis might have other issues relating to the pelvic floor dysfunction, like leaking or something else. I definitely see it associated with other issues. If your core is not strong that can have a lot of downwind effects, so someone could have... I've seen people with a weak knee, like a knee pain let's say, or a weak hip, and then ultimately their core is weak, they have a diastasis.
0:14:33.3 Marci Silverberg: So if your core is weak, that's the center of your body, you can have other problems up and down the kinetic chain that are related to a weak core. So it's definitely important to rehab it, although the clinical evidence doesn't prove that. What I see clinically is that it's definitely important to rehab it, and have a strong and functional core for life and for whatever activities we're doing.
0:14:58.9 Kim Schlag: Is there a certain window of time that a woman has to work on healing this after she has a baby? Or is it something that let's say... One of my listeners is listening and she's like, "Oh, I'm 45 and I had my last baby 10 years ago, and I have this." Is it too late at any point to work on healing this?
0:15:21.5 Marci Silverberg: Absolutely not, it is never too late to work on it, and I see that a lot. I see women that never really did rehab after they had their baby, and then they're coming in for rehab and now they're 50 and they have, you name it, a hip problem, they have leaking, and then we find that the core is weak and it never was really rehabbed. It's never too late and go back and rehab it then. The body remembers and just kind of holds on to it until we get to it.
0:15:49.6 Kim Schlag: I have to say I had never even heard of this when I was having children. So my kids are all older, now I'm 50, my youngest is 15 and a half. I had never heard of this term until several years ago. And so, is this something that is just becoming more like that women are becoming more aware of it? Or is it just happens that you think it may be just in... I just didn't happen to know anybody with it, or do you think that a lot of women are just now becoming aware that this is a thing?
0:16:17.4 Marci Silverberg: Women are just becoming aware of it, absolutely. The whole field of pelvic floor physical therapy is really growing now. So there are definitely pelvic floor PTs that were treating this problem in the '80s let's say, but not a lot, and now there's more and more pelvic PTs, and we're talking about these things. So women are starting to learn that if they're leaking after having a baby, that that's not normal, and that they should get treated for that. And that if they have this issue called diastasis, that there's people like me who are trained to help them with it. And so PTs is like, we're getting out there, like we're doing podcasts, and we're doing vlogging and we're on social media so that we can talk to women. That these things do happen and that there is treatment for it, so they don't have to just deal with it. So people are probably just hearing about it a lot more lately, and that's a really good thing.
0:17:09.5 Kim Schlag: And so, if someone who is listening right now and they're like, "Oh, this sounds like me". Whether they recently had a baby, or it's been 10 years, or somewhere in between, what should they do? If they're like, "Okay, yes, this is me".
0:17:20.5 Marci Silverberg: Yeah, so I think the best thing to do would be to work with someone like me who's a physical therapist and is trained in working with this, and there's also personal trainers that are trained in working with women postpartum. So finding someone who has the training and the knowledge in this area, and there's some websites that I can point you to to find somebody, or just finding a good local women's health PT. Even if you just go to your local PT clinic and ask how do they treat this condition, or who do they refer to that has training in this. Or you can look at this, there's some websites, I could point people to find someone with the training in order to work with them.
0:18:00.7 Kim Schlag: And so if someone was gonna come to you for this, give me a general idea of like, what are we talking about? Are we talking about exercises, or what is the gist of the treatment?
0:18:11.9 Marci Silverberg: So I look at everything. So when I work with someone and they're coming to me with this problem, I wanna know everything about what's going on. So the way I start with people is, I do an evaluation and I have them fill out some paperwork. So I wanna know what else is going on, if they're noticing they have a diastasis, are they having back pain, are they having any pelvic floor dysfunction? So specifically, are they leaking? And this could be like bowel or bladder. Are they leaking, are they having pain with intercourse, are they having a feeling of dragging in the vagina, what other orthopedic conditions do they have? We mentioned if you have this, there might be other issues up and down the chain, knee issues, hip issues, anything else going on. And then I'm gonna evaluate them and I'm gonna see... Treating this is not just about exercise, it's really a whole body approach, so I'm gonna start and I'm gonna look at, how does this person stand, right?
0:19:05.0 Marci Silverberg: If I have a mom who just had a baby and she has a diastasis and she's still standing like she's pregnant, which a lot of women might do, she's putting pressure on the front of her belly and causing... Kinda leading to more of that like split, more of that feeling of pressure in the front of the abdomen. So I have to work on the alignment piece first, and then I look with every single client, how are they breathing? 'Cause I can get into this, but how you breathe is very connected to how your core works. So I need to look at these foundational things first, and then I'm gonna evaluate the diastasis, and then I'm gonna see what this person needs first. So the treatment is always gonna be alignment and looking at breathing patterns, and then it's probably gonna be looking at how they sit at the computer, and how they pick up their kids, and different things about how they use all the muscles of their body. And then there might be some corrective exercises to help with the diastasis and generating tension.
0:20:02.7 Marci Silverberg: But there might be other things going on. Some women will have weak pelvic floors and that needs to be treated in order to close the diastasis, 'cause the pelvic floor and the muscles in the front of the abdomen are very intimately connected. So that might need to happen. Some women are really tight in other muscles that connect to, and in effect, that linea alba. So I have women who, when they go to use their core, they grip with their external oblique, these muscles on the sides, and they need to learn to not do that, and we need to do some release work. So there might be manual work that I need to do to release different muscles of the body. Sometimes the ribcage is flared from pregnancy and I need to do manual work on the thoracic spine, so I'm looking at everything above and below. I'm doing usually a full plan of care, so it's education, it's exercise, it could be stretches, it could be, this is how to stand at your computer, you know, it's very holistic how I treat it.
0:21:02.5 Kim Schlag: Got it. And what does a typical course of treatment take, so from the time somebody's like comes to see you until this is very well healed. How long are we talking?
0:21:13.7 Marci Silverberg: Yeah, I usually evaluate a person and get to know them in order to understand what their goals are. It's very much goal driven. So if I have someone who says they wanna be able to just return to exercise and know what exercises to do, and beyond the course of healing this, because it could take a long time to heal it. I might give them maybe six sessions, if I have someone else that say they have a diastasis and they're leaking and their goal is to run 10 miles, they have goals that require me to train them for a specific activity that's more difficult and more loading, so I might be working with them longer. So it depends on the individual, it depends what their goals are and how they progress through treatment, but I would say on average, I probably see people around six to 10 visits, but it's variable.
0:22:02.3 Kim Schlag: Okay, got it.
0:22:03.9 Marci Silverberg: Yeah.
0:22:04.0 Kim Schlag: Got it. Now besides diastasis, what do you think are the other top two pelvic health issues that women come to you for?
0:22:14.6 Marci Silverberg: Yeah, so top two, definitely leaking is one. So leaking urine. And I would just say that it's very common that women's leak, I think like 40% to 50% of women postpartum are leaking to some degree and that's definitely the number one thing. And it could be presenting like, "I'm leaking when I cough or sneeze," that's one type of leaking called stress incontinence, or it could be, "When I get the urge to go, I just have to go to bathroom immediately," and that's called urge incontinence. And they're treated differently. And when it comes to that, I would say any leaking is not normal and should be treated. 'Cause sometimes women will say, "Well, I only leak a little bit..."
0:23:00.9 Kim Schlag: We all think it's normal.
0:23:01.3 Marci Silverberg: Yeah.
0:23:01.3 Kim Schlag: I have to say, so you're my second public health physical therapist I've had on the podcast. I think it was about almost two years ago, I had a woman by the name of Hannah Ross, and we talked in depth about that. I will link that episode here. And I remember saying [chuckle] like, "I just thought it was normal that I leaked." You know that like, "Oh, of course I pee a little bit when I sneeze or when I jump 'cause every... All of my friends do too," and it's one of those things you don't realize like, "Oh, this isn't actually supposed to be happening, and it is fixable."
0:23:30.3 Marci Silverberg: It's fixable. Yes, absolutely, and the earlier you treat it, the better. If it's been going on for a really long time, it might be a little bit harder to treat and reconnect to those muscles, so it's important to get it treated. And the thing I love sharing with people, I'm very passionate about treating women for leaking, it's factually, it's the number one reason why older people end up having to go into higher levels of care like nursing homes and assisted living.
0:23:56.9 Kim Schlag: Really?
0:23:57.4 Marci Silverberg: It's just because of the leaking and the incontinence, yeah.
0:24:00.1 Kim Schlag: That is so interesting.
0:24:02.3 Marci Silverberg: Yeah. And so it's so important for your lifestyle to just...
0:24:06.1 Kim Schlag: Alright, you may have just inspired me to finally make a dang appointment with a pelvic health physical therapist. 'Cause I always saw it like, "I should just get this, I should go see somebody, I should go see somebody," and I just never put it on my top of my priority list to do. That makes it feel really important to me.
0:24:23.0 Marci Silverberg: Good, I'm so glad. Yeah.
0:24:25.2 Kim Schlag: The fact that I pee my pants when I cough and I've been sick for three months, you think it would have been important already, [chuckle] but this kind of nudges it even higher.
0:24:33.5 Marci Silverberg: Absolutely, and it has such an effect on quality of life. Women, we're so good at transferring that, "Oh, we'll deal with that later," because there's all these other more important things that seem on the list. But the thing is, it affects your quality of life, right? If you're afraid you're gonna... I feel like, I don't have those issues, but if I was afraid I was gonna pee, then I start avoiding things. And I see it all the time. The first client I had, I took these courses, I learned how to do internal work, I get my first client who's leaking, and her story is classic, she's been leaking for three years, her doctor said, unfortunately, that there's nothing she could do about it other than get surgery, which is a shame 'cause it's fixable most times with conservative care. So she's leaking, so she doesn't exercise because she feels embarrassed 'cause she leaks when she exercises. And because she's not exercising, she feels more stressed, so she eats more and then she gains more weight and then it affects her body image and now she's not having good relationship with her husband. So it has this huge spiral effect, and I think that that can happen in lots of different ways. So it's not just leaking, if you think about the impact it has on your life.
0:25:39.8 Kim Schlag: It can have a long reaching impact, absolutely. So tell us one more. What's another top issue women come to you for?
0:25:47.4 Marci Silverberg: I treat a lot of women with pelvic organ prolapse.
0:25:51.6 Kim Schlag: Okay. And how does that happen?
0:25:54.1 Marci Silverberg: Yeah. So what it is, is you have these three organs in your pelvic cavity, you've got your bladder, your uterus and your rectum, and they have their place that they live, and they're connected by fascia ligaments, they stay in their place, and they can shift a little bit. They could shift downwards a little bit, and what that could look like or feel like for a woman is, she'll say she has a feeling of dragging vaginally or it feels like something's coming out of her vagina, is what it feels like. It's a very uncomfortable feeling, and that's another one that is treatable most times with conservative care, so that's one that it's graded. It's graded from levels one to four, and when it's a four, that means it's like completely outside of the vaginal entrance, and then at that point it needs surgical repair to come back, but it's another one of those things that are progressive, and this is actually one of the things that made me feel really passionate about working with women.
0:26:52.7 Marci Silverberg: So I learned that after a woman has a baby, the incident of pelvic organ prolapse, the incidence is very high, it's like 30% or 40% of women have this. But a lot of them don't even know that they have it, because they might have this really mild form, like a grade one, and you don't really start feeling it until you're about a grade two. So now in my practice, typical situation is a woman calls me and she's in, say her 50s or her 60s, and she says, "Oh my God, all of a sudden I feel like something's falling out of my vagina, and I go to the OB and I get diagnosed with pelvic organ prolapse," and she's in a panic, "Can you help me? I don't wanna have surgery." And absolutely, I work with her and as long as it's not severe, oftentimes, I can help her with the symptoms and we could reduce the prolapse, not completely, but by a little bit, but the thing is, it's like it's the straw that broke the camel's back. This process was in play for a long, long time, and one day it just got to the point that she felt it. Okay, so she probably was never checked. So I check every client to see if they have any kind of pelvic organ prolapse and even if it's mild, I want them to know so they can start treating it and they don't end up that woman that's 50 calling me in panic.
0:28:13.0 Kim Schlag: It feels like as women, we're really disconnected from our pelvic health and what should be happening and what shouldn't be happening, and what's just normal, and what even though it is common, is still not normal.
0:28:25.2 Marci Silverberg: Absolutely, absolutely. I talk about this all the time, I give classes about it, I just don't think that we as women are really educated about our bodies and our pelvic health, and part of it is that a lot of women really are uncomfortable talking about pee, poop and sex.
0:28:42.6 Kim Schlag: Yeah. [chuckle]
0:28:43.2 Marci Silverberg: I call myself, I'm a physical therapist that talks really openly about pee, poop and sex, and so let's talk about what's normal and what's not normal, so that women can know if something's happening to them that it's not normal. Certain things are not normal. They may be common, but that doesn't mean that they're normal or that there's nothing they could do about it. And so those things would be leaking, and that could be urine or it could be stool. Feeling like something is dragging out of your vagina, seem like that gap, that diastasis when you're doing exercises. And the other one that we haven't talked much about, but is having pain with intercourse, those are the main ones that women suffer with, and they just think that there's nothing they could do about it. Now those are the main things.
0:29:30.0 Kim Schlag: And so what would you say to women out there listening, what's the one thing you would say, "Here's what I want you to know about your pelvic health, if you know nothing else about it, you start here."
0:29:45.2 Marci Silverberg: I guess all those things that I mentioned. Do you know I start where I like to tell women about their pelvic health is? I just like to start with a model and just show like, this is where your vagina is located, this is where your pelvic floor is located, and just know that... And I said it before, but which it's not normal to leak, it's not normal to have urgency around going to the bathroom, it's not normal to have pain conditions either with intercourse or just around the pelvis and around the back, and it's not normal to feel like things are falling out. Physical therapists also treat women who have really painful periods, that's another problem I really deal with.
0:30:25.0 Kim Schlag: Oh, really.
0:30:26.3 Marci Silverberg: Yeah, we help women who are very constipated, that can be a pelvic floor issue.
0:30:30.7 Kim Schlag: Interesting.
0:30:31.6 Marci Silverberg: So we can help with dietary recommendations to help some things flow through, but that can be related to bowel health, and there's things that we do for that, and abdominal massage and there's lots of different things that we treat. But basically, if you're having discomforts, you can talk to a pelvic PT and see if there's things we could do, 'cause a lot of times there's things that we could do for discomforts that people think are normal and definitely pregnancy-related discomforts, I treat all the time that women might say, "Oh well, I'm pregnant, so of course I have back pain." 90% of women when they are pregnant have back pain, but I treat women who are pregnant with back pain all the time and get them feeling more comfortable, like why suffer with it. You know?
0:31:12.2 Kim Schlag: Yeah. We don't need to suffer. So you said something interesting back at the very beginning when we first started talking, and I didn't bring it up then, 'cause it wasn't kind of the whole point of the podcast, 'cause my audience is women, but I was so interested in it. I'm sure a lot of these women have men in their lives, they love. You mentioned women and men with pelvic health issues, so what kind of pelvic health issues do men have? I never, ever thought about men having pelvic health issues, but obviously you have a pelvis. So what kind of issues do they have?
0:31:41.2 Marci Silverberg: They can have pain conditions around their pelvis or around their private parts. They have prostate cancer sometimes, so then they get rehabilitation after surgeries. They can have the constipation issues, they have sexual dysfunctions as well, they could have things like pain with orgasm. Yeah, difficulties with sex, difficulties with maintaining or getting an erection, that could have to do with the muscles and how the muscles are working down there.
0:32:16.7 Kim Schlag: Do you work with many men?
0:32:19.1 Marci Silverberg: I don't. I'm mostly working with women right now.
0:32:21.6 Kim Schlag: Got it.
0:32:22.6 Marci Silverberg: Yeah. I think maybe later on in my career, I plan to start seeing more men, but right now I'm just seeing women.
0:32:28.2 Kim Schlag: Okay.
0:32:29.2 Marci Silverberg: Yeah.
0:32:29.6 Kim Schlag: Well, this has been an enlightening conversation, I'm sure people listening have definitely learned something that they did not know before, and hopefully a lot of people will take the next step to get themselves some help, because we don't need to be having... We don't need to be peeing on ourselves and having discomfort and just living with it and accepting it.
0:32:48.2 Marci Silverberg: Absolutely, I agree. Yeah. That's great.
0:32:50.7 Kim Schlag: Thank you so much for coming on, Marci. Where can people find you if they want to talk to you more about these things?
0:32:57.3 Marci Silverberg: Sure, you could find me on the Internet, and my website is www.marcipt.com.
0:33:06.0 Kim Schlag: Amazing. Well, thanks so much. We sure appreciate your time and your expertise in this area.
0:33:11.8 Marci Silverberg: Thanks so much for having me, Kim.
0:33:13.4 Kim Schlag: Thank you, bye-bye.
0:33:19.7 Kim Schlag: Thanks so much for being here and listening in to the Fitness Simplified Podcast today. I hope you found it educational, motivational, inspirational, all the kinds of -ational. If you enjoyed it, if you found value in it, it would mean so much to me if you would go ahead and leave a rating and review on whatever platform you are listening to this on. It really does help to get this podcast to other people. Thanks so much.
I'm a NASM certified personal trainer who is passionate about helping women transform their bodies through strength training and sustainable nutritional habit changes.