The Truth About Your Pelvic Floor After Menopause

[00:00:00]Okay. Hi everybody and welcome back to this episode of Tea with Sophie. I am so excited about today's conversation. We are going to be talking about something that affects millions of women, but very few of us ever talk about it openly. And today we are going to. So if ever you have leaked urine when you have laughed or sneezed or in other places there's been some kind of incontinence going on if you exper if you've experienced painful sex recurring bacterial infections UTI constipations feelings of heaviness and and pressure back or hip pain that no one's ever been able to explain or you've been simply told oh that's just what happens after menopause this episode is for you. So, my guest today is the wonderful Leslie Howard.

[00:00:50]She is an internationally recognized yoga therapist, educator, and one of the world's leading experts in pelvic floor health. So, for more than two decades, Leslie has helped thousands of women better understand and help them heal their pelvic floors through her pioneering work in pelvic floor yoga.

[00:01:11]After overcoming her own experience with pel pelvic floor dysfunction, she developed a therapeutic approach that combines anatomy, yoga, breath awareness, and self-incquiry to address issues such as incontinence, pelvic pain, prolapse, and other common but often very misunderstood pelvic floor concerns. Interestingly, she designed she's a science gal like me. She designed two clinical studies with researchers at the University of California, San Francisco using her methodology which fascinatingly uh it demonstrated significant improve improvements of symptoms of incontinence and pelvic pain. Today she teaches workshops and professional trainings around the world has educated thousands of yoga teachers and healthcare professionals in her approach to pelvic pain. That was a long introduction, but I'm going to uh int have you come on in.

[00:02:06]Hello, Leslie.

[00:02:07]>> Hi. Thank you for [laughter] having me.

[00:02:09]Your enthusiasm is contagious.

[00:02:12]>> Oh, well, I am so uh I'm so excited and thank you for giving us your very, very precious time because I know how busy you are. So, we're going to get straight into it. Now, Leslie, you have blown my mind. So, this is Leslie's book, and I'll drop you a link to it in in the description and show you all of that good stuff later on in the interview, but Leslie's book is called Pelvic Liberation. And I honestly, Leslie, thought, okay, we're going to this is going to be just doing some kegles and some yoga kgles, [laughter] whatever it was. and your book blow blew my mind and honestly from my heart to yours because I have suff suffered with a lot of the symptoms that I've spoken about a lot of them ladies and have felt very alone with that very embarrassed have gotten inadequate answers for my OBG where I am something's helpful some things just not feeling very stuck and very very alone and reading your book was it just opened my heart because the way you speak about the pelvic floor and the anatomy it's ladies you listening and you watching this conversation goes so much deeper than what you would normally be told to do which just you've got to do a few kgles so I am going to um jump in straight with you Leslie why don't we talk about the pelvic floor >> well that is a very good question but um I think we have to look at it culturally. I think that um you know we have puritanical roots in this country um until you know the 60s really women didn't have equal rights. We still don't have equal rights but it things are definitely better. So I think there's a taboo on talking about this. Um I think there's shame. I think there's a lot of shame uh around incontinents and pelvic pain. Like if you're having painful sex and everybody you you have this illusion that everybody else is having great sex except for you, you don't want to be the person that talks about it. But I find that if I encourage people to talk about it, um like you can't you can't get them to stop. Um because everybody's looking for a place to not feel so alone as you said. Um it's it's very very common. Um and that is one of my main tenants of teaching this is um like can we just we talk about almost every other body part without any like shame or embarrassment like can we just normalize the conversation around pelvic health.

[00:04:57]>> That's so beautiful. And and I think you've really you've keyed on in on a word there which is a word that I so often address Leslie in in my coaching is shame. And and I think so many of us uh have and and your book so beautifully goes into where that shame might have come from and how we we we we sort of shut down because that shame by the way may well this is for the listeners and not to you Leslie because you write about it in your book but the shame goes back for many of us many many many years. there's a long deep rooted history of shame in even dealing with and talking about and feeling that area of um our body. And so thank you for for saying that and for writing about it in a way that we can really speak openly and not feel alone. So, I I think I I want to start with you giving us a a better understanding of actually what the pelvic floor is because until I read your book, I was just like, "Okay, it's just a muscle." Okay, I get it. It's a muscle. It's just down there and it's a muscle and it gets weaker and lax with age and causes all these problems. That honestly was as sort of as far as I had really got there. So for somebody who's never really thought about it, what exactly is it? What is what is its primary job or jobs plural and um and and and also I know there's a lot here in this question but relating it to breathing as well. So I'll hand all of that over to you.

[00:06:36]>> Okay. [snorts] If I forget part of it, you'll remind me. Okay. So what is the pelvic floor? The pelvic floor is actually not one muscle. It is a set of muscles at the base of our um pelvic bones and they uh basically I'm going to I'm going to not go to like nuance of anatomy but I want you to think about them as attaching from the front to the back. So it attaches to the tip of your tailbone to the back of your pubic bone.

[00:07:04]And then you've got another set that is uh goes across left to right sitting bone to sitting bone. So, the bottom bones on the pelvis that we sit on, sometimes called the sitsbones. And um and then there's a a deeper layer. The deepest layer also connects to the tailbone, but not to the tip, more to the sides and and has kind of um a horseshoe shape. So, it attaches to each side and comes around and again attaches behind the pubic area. So it's a set of muscles that ideally work together when everything's working well. But if you are a human being that has uh has lived on the planet for a while, we have all been through something. So those muscles can be affected uh especially with uh child birth, right? They get damaged a lot. They tear sometimes if there's um a difficult uh labor. sometimes they can get cut by by the surgeon. Uh so then you've got scar tissue in that area. Um so they're m they're basically very responsible for things coming in and things going out. So if you are peeing and pooping every day, which I hope you are, >> [clears throat] >> um your pelvic floor is involved in that. If you're having penetrative sex, then that's controlling uh something coming in. Um, if you are having a baby, they're helping to get things out. So, you want a pelvic floor that has tone.

[00:08:37]Um, so like like every other muscle, like you said, Sophie, um, it is like every other muscle in that it needs to be strong and it needs to be flexible.

[00:08:49]And what I have found in my work is that um, there's a myth of looseness. It doesn't mean that you're not loose. You might have a looser pelvic floor, which means the muscles are in a lengthened position and do not engage well. So, if my hand is stuck open and I want to close it, it won't close. So, that would be an analogy, right? But I find more people are actually weak because they're in a tightened position. Like my hand is clenched and I can't open it very well.

[00:09:21]So, the pelvic floor can be too loose.

[00:09:24]It can be too tight. And then of course, annoyingly, it can be a little bit of both. You could have one side that's too tight and one side that's too loose because a lot of us have done asymmetrical things in our lives. We hold our kid on one hip. We do asymmetrical sports where one leg is dominant. We may have had an accident on one side of the body and not the other.

[00:09:46]Again, there's a million reasons why your pelvic floor might not be working, but um that's basic anatomy. Um, of course, I can go into it for a lot longer, but I won't. And then you asked me about breathing. So, the pelvic floor is very integral in uh it's in a reciprocal relationship with our respiratory diaphragm. So, our breathing muscle, our respiratory diaphragm sits at the base of the rib cage. And it's basically a circular shaped muscle that when the lungs fill, the respiratory diaphragm moves down to create more space for the lungs to take in air. And then as we exhale the air out, that kind of flat shape domes up. Okay? So that's the respiratory diaphragm working with the lungs. The the pelvic floor is below all the organs in the body. So if you think about the respiratory diaphragm being here and the pelvic floor being here, they ideally should be in sync. So as we inhale, the respiratory diaphragm flattens, moves down. At the same moment, your pelvic floor should be doing the same thing. If your pelvic floor is in good shape, the pelvic floor helps rebound with the exhale. So, it should be lifting a little bit like the respiratory diaphragm. So, this is it's like breathing should be like this ideally. So, what I see a lot of I just I really want to mention this because it's so common is most people that I see with pelvic floor challenges are what's called reverse breathers. What that means is when their respiratory diaphragm is moving down, their pelvic [snorts] floor is moving up. Now, where does that come from? That comes from [gasps] trauma. When we we when something scares us, when we're fe we're full of fear, we go [gasps] and what happens is our pelvic floor lifts because we're either getting ready to you've heard the fight or flight. So your pelvic floor is lifting up to get you to fight back in some way. And then what happens for a lot of people is you get stuck in that pattern. Um that can be one reason for it. Another really common reason is women have been brainwashed from day one that their stomachs should be flat. [snorts] Okay?

[00:12:14]And I will dare any of you to send me a statue from antiquity with a flatbelly woman. Okay? If you go to the Met in New York and look at the Greek statues and the Roman statues, the women have this beautiful soft little belly. It's not like this flat washboard thing that is just not really good for us. That that is that is not helping you in breathing.

[00:12:39]So that that's a couple things that can uh contribute to pelvic issues.

[00:12:45]>> Wow. There's so much there. and and and ladies, you this is Leslie explains this so deeply and eloquently. You're such a great writer in her book. I think those two things are the things that really really jumped out at me. Um and I just want to take them I want to double click on both those things. I want to I want to come back to the breathing in a moment. But the the thing that I did not understand and and Leslie I have spoken at length to my OB/GYN about this. I have spoken to other sort of pelvic floor people. Nobody has explained it to me in the way that you have which is there are two different estates. There is I think you call it hypertonic versus hypotonic which which as Leslie was explaining for those of you who are listening and watching that the it's not just that you've got because I think we all think oh it's just lax you know we've given birth we've got we've got this weak pelvic floor and that's why we've got all these problems and it was such a revelation to me to understand by reading your book in detail no that's actually not what it is. And also that you just said that it can be a little bit of both. But for me, it normalized the fact that there was the painful sex, the vaginal atrophy, those things which are very very very I'm not even a little bit common. Like I would think honestly that 90% of postmenopausal women have some degree. I I mean I'm pulling a stat out here. I don't know this for sure.

[00:14:25]You probably know better than I do. But I would imagine that the majority of us have vaginal atrophy which that I would imagine coupled with years because reading your book it could be years of being hypertonic right being too tight there can cause issues and then you I mean and then it gets even more complex if you've been like that for many many years and then through childirth than menopause where lack of estrogen completely changes all of your muscles including your pelvic floor then you've probably got some hypotonic some laxity as well. So for the for the listener and the viewer, Leslie, how could somebody tell what I mean? What if somebody's sitting here going, "Well, how do I know if I'm hyper or hypo? Where where do I go from here?

[00:15:28]I know I've got problems, but how can I even find out whether I am? What would you say to the listener or viewer?"

[00:15:35]>> Okay. [snorts] Um, good question.

[00:15:37]Another humongous question. I'm gonna I'm gonna talk in broad brush strokes again because I I like to say that never underestimate the power of the body to be confusing. [laughter] So, you know, I think I've seen it all.

[00:15:52]Then somebody shows up and I'm like, "Wow, I've never seen this." But, u I'm going to say um that there's different types of incontinents, okay? And I'll talk a little bit about that. So, the most common types of incontinents are called either stress or urge. Okay?

[00:16:09]Stress incontinents is what you were describing um about laughing, coughing, sneezing, and you get a leakage of urine. Um let's say you go on the trampoline. I hear this from a lot of moms. I can't be on the trampoline with my kids anymore because I'm I have such bad incontinents. Um that is a stressor on your pelvic floor. Therefore, the term stress incontinence. So a stressor on your pelvic floor means there's more pressure down than normal and your pelvic floor is not able to respond to the moment of pressure. So like maybe you're picking up a weight and you you leak a little bit. Your pelvic floor is not strong enough to meet that moment.

[00:16:54]Now as you again uh mentioned hyper hypertenicity means too tight. Hypo is too lax. Your pelvic floor is weak. If you're leaking, your pelvic floor is weak. What we don't know is it too tight and weak and can't respond to the weight or the pressure of a sneeze or is it too loose or is it a combination? So, further further questioning. So if you have stress incontinents and you also have chronic constipation, that's going to point a little bit more towards more likely hypertonic. [snorts] Um, if you uh are leaking with pressure like that and you don't have constipation issues, maybe you uh are not very active, uh maybe you have a nineto-five job where you're sitting a lot. uh you know that might indicate laxity. I'm going to tell you another way to tell in a moment, but let me get through all the conditions. Okay. The other type of condition is called urge.

[00:17:59]And some of you, I'm sure, are familiar with you're going along your day and then all of a sudden you're like, "Oh my god, I have to pee so bad. Where's the nearest bathroom?" And it can happen like you're in the car and you're like, "Oh my god, do I have to pull over on the side of the road?" you you have this urgency, hence the name. Um it's very nervy feeling. It's it's very hyper feeling. Whereas with stress incontinence, you don't have that. You don't feel like you have to go to the bathroom. With stress incontinence, you just leak. Urgent consonance is this overwhelming uh feeling that you have to urinate and then sometimes you make it and then sometimes you might leak a little bit before you get to the bathroom. Urgent contents is always always tightness.

[00:18:43]Okay. So stress a little more complicated. We don't know yet. I'm going to get there. Urge if you have the urge incontinence that's indicating too much tension. Um and then pelvic pain also 100% you have tight muscles because as a human being what we do when we're experiencing pain in any part of our body is we clench. So, if you're having pelvic pain, you are your muscles in your pelvis are getting shorter and tighter.

[00:19:14]What we still don't know is the the symptoms that you're having. Let's say you're having pain and urgent continents. Is that is it because you're a clencher because something happened to you 20 years ago and you've been clenching for 20 years or are you clenching as as a result of a condition you have? So there are other conditions you could have that could cause pain like something called vulvadenia where you have pain of your genitals. Um you could have interstitial cyitis which is bladder pain. So if you have pain in that area you might be clenching but the clenching whatever you're why for whatever reason you're doing it. It doesn't help it makes your pain worse.

[00:19:55]Okay. So now you're like okay so if I have urgent continents that means my m my muscles are tight. If I have pelvic pain, that means my muscles are tight. I still don't know about stress. So with stress, what I would encourage my students to do if they were st still kind of not sure is I would have them over the clothes, just massage the area around your sitting bone. And if you don't have any like, ow, ooh, that's tender. If you don't have any of that and it feels maybe even a little mushy, um, that's going to indicate laxity. Um, if you if you give yourself a little sitting bone massage and you're like, "Wow, that is so tender. That is that's an indication of hypertenicity." So, I think I answered that whole question, but let me know. [snorts] >> Yeah, you you really answered it. It's just I'm listening to you and I'm just there just you we're uncovering there's so many layers to uncover because I know in just a short amount of time in this interview I'm I'm asking you to extrapolate pieces which are part of of complex work that you will do with women because an anatomically I it's it's complex but but also emotionally it's really complex as you were speaking and even when you said that bit of like Well, maybe you've got this this this tightening because of something that happened years and years ago. There is so much to unpack there as well. And then it what I'm just realizing as you're speaking is that we can have these um these traumas that we've been through or these sort of insults or whatever. It can be physical, mental, um emotional. And then we bring all of that with us undelt with no therapy there on certainly on on in this area that we're talking about. Then you bring that into menopause.

[00:21:57]And then in menopause, there's all these other things that are happening in your body that are making you feel so upset and and all these other symptoms. and the the the estrogen plummeting which affects would you talk a little bit about that specifically how the hormones and specifically uh estrogen uh plummeting how that adds to this whole picture for a woman who is in menopause or postmenopause.

[00:22:36]>> Okay. Um I I I will answer your questions about menopause. I also want to comment on something you said about you know like some I I mentioned like trauma from 20 years ago. You know I don't want to I don't want to come across as critical of the medical um community because things are definitely getting better but the medical community in general is very siloed. And what I mean by that is we don't have an integrative approach. So you can go to therapy for the thing that happened to your pelvis like sexual abuse or something but you're not your your psychoanalyst or you know isn't talking to the doctor or your pelvic floor physical therapist like we don't have this more integrative uh view of health and so that is something that I very much explore in my book only because it was my journey I had to ask myself I had to look at what had happened to me and um because because your pelvic floor just doesn't stop working one day. It's like a lot a lot of things. It's usually like a lot of things over a long period of time and then one day you're like why is this happening today? All I did was reach across the table and for the salt and all of a sudden I had this searing pain in my tailbone but then as you unpack it you remember that you know you fell on your tailbone you know multiple times when you were learning to ski or something like that. Okay. So, I just I want to I want to just say that um as far as hormones, okay, so then like you've got the pelvis that you have uh at the age that you're going through menopause and then it's like a triple whammy. You your estrogen plummets, your progesterone goes down, your collagen goes down. So, frustratingly, you have to work much harder. Like, let's say you're someone who stays in in shape and you work out a lot and you're like, "Why is my muscle tone? Why am I losing my muscle? I'm doing the same thing I've always done. You have to work much harder to maintain it. Okay. The upside is you get to live through that. Okay.

[00:24:33]There was a time in this country where people didn't live as long as menopause.

[00:24:38]So keep that in mind. Um [laughter] so when you get hit with menopause, your your muscles are going to have less mass. Okay? So, whatever thing that you were brewing in your pelvic floor, I'm going to talk pelvic, but but it also applies to all of your muscles. Let's say, let's say you were, you know, slightly hypertonic, but it didn't you didn't really affect your life so much that you even realized it, but then all of a sudden you go through menopause and the muscles of the pelvic floor are now a little a little less strong.

[00:25:15][snorts] And and remember, strong can be too tight strong or too loose strong.

[00:25:20]So, let's say you have a little bit of laxity. You've never really noticed a problem, but this is a lot of times this is where women experience incontinence for the first time because they've lost muscle mass in their pelvic floor. And we've never really been taught to even know about it. First of all, we we didn't even know it was there. And then to find out that it's actually an at will muscle. It's it's striated muscle just like the muscle in your biceps and your hamstrings. That means that you should be able to at will engage it, but we've never been taught that except for do your kegles. That's another rant that I'll hold off on. Um so, um the other thing that happens in menopause besides the loss of all those hormones, which you know, of course, give you a lot of sexual drive, is the uterus, if you still have your uterus, if your uterus uh is still in place, it actually shrinks a little bit. And why that is important is because you you have um support in your pelvic floor from musculature, from ligaments, the ligaments that hold your pelvic organs. So in a body born with a uterus, you have a bladder in the front, a uterus in the middle, and and a rectum in the back. Those three muscles kind of lean against each other. If you can think of it like lean like they lean into one another. If you've ever kind of stood shoulderto-shoulder with somebody and you kind of each support each other and then the uterus shrinks a little bit. So then there's a little less to lean into. And so if you had a little bit of looseness in the ligaments, if you had a little bit of looseness or tightness in the pelvic floor, then you might all of a sudden go for your annual and your gynecologist says, "hm, you have a little bit of a prolapse." Okay?

[00:27:11]So, it's like a triple whammy uh going through menopause, but yay, we get to go through it.

[00:27:19]>> Not to end on a negative.

[00:27:21]>> It's not. No, not at all. And that Oh, this is just so fascinating. I think again the thing that is fascinating about your book is that you you open up the conversation about all of these things that I never never thought about before. Just what you've just mentioned then and how everything is integrated.

[00:27:46]You can't, as you say, the medical profession is infuriating because everything is so separated and even just hearing you speak, it's like if you had urine issues, urine, you're going to go see a urologist, right? If you've got if you've got then you've got your OBGYn for this if you have a and everything is completely separated and it's just to to have your book and this conversation where you are bringing everything together actually gives so much understanding and and solace to what is what is really really going on.

[00:28:27]Um, so if there's so many different places we could go in this conversation. I I I I I I want to have you on for like two hours, [laughter] but okay. So So here we are. We we we're in we're in most of the women that I speak to are are over 50. And now we have this understanding that as you beautifully said, we have this series of muscles. It is not one muscle. It is series of muscles that make up the pelvic floor.

[00:29:02]And much like any other muscle in our body, which I've never thought of before, Leslie, I talk a lot to to everybody about psychopenia, loss of muscle mass as we get older. got to get in the gym. Gotta and even that in the in in the way that I speak about that there is so much nuance because it could you can be completely imbalanced. If you're heavy lifting in the gym and you are getting too tight and you don't have the flexibility and mobility then there's going to be problems. So everything has to be integrated and has to be balanced. is not cuz you now you the the the the trend has swung in the direction of we've all got to be weight training in the gym and getting eating you know the whole thing and eating tons of protein but it's the pendulum has swung I think a little too far in that direction we have to come back to balance but all this to say is so this muscle needs equal an equal amount of attention ladies than our the muscles that we actually see in our arms and our legs oh and I'm not going to forget the little beautiful piece that you said about the belly and the six-pack and, you know, [laughter] having this beautiful soft um belly, you know, and and and and that's so important. But paying attention to this muscle. So for those who are listening and those who are watching, what you you said you're going to come back to the kagel conversation. Let's come back to it right now. So what I have been led to believe and taught in many different ways both through yoga and I know this is getting a little nuanced because we get we can get into the mulab and and and whatnot in that um and that might be a little bit too much for this conversation but suffice to say that I think most of us have been taught we need to do our kaggels some version of a kaggel and we've been taught that we either there's lots of different ways that it's taught But we got to lie down or sit down or every time we're on the toilet, we've got to stop the the stream of the pee and just grip as hard as we possibly can 15 times and [laughter] and do through the the you know the whole part of the thing. So here we are. We all want to pay attention to this beautiful set of muscles now as much attention and love as we as we um give to all these other muscles. What do we do Leslie? Where do we begin?

[00:31:32]>> Okay. [laughter] Um, okay. So, yes, you heard like pretty much until very recently if you had any problem in your pelvis at you with in a female body >> and you went to the doctor, they would say, "Well, are you doing your kegles?"

[00:31:50]And often you didn't even get an explanation of what that is. It's like you you're somehow in your hardware. You should just know what that is. And my definition jokingly of a kegle is squeezing everything below the navl and hoping for the best. [laughter] That's my definition of a kegle because because that is what a lot of people do.

[00:32:14]They they they're like, you know, squeezing everything. And if your pelvic floor is already too tight, guess what?

[00:32:23]That's not good for it. And if it's too lax and you're tightening everything, everything might be tight except for your pelvic floor. So, you know, a core part of my teaching is can you can we tune in to this part of the body and actually see what it's doing. Um, I also want to say that until very very very recently, gynecologists were not taught about the pelvic floor muscles, which is kind of like what? Okay. So, the only the people who know the most about the pelvic floor in my opinion uh in the medical community are your physical therapists that have specialized in it.

[00:33:00]And there's a lot of them and they're usually you you can find them, but there's usually a wait list because there's not enough of them. Um so, they know a lot about the pelvic floor. Um I and they're my community. I've tal I talk with them a lot. We refer back and forth. I'm bringing that in because they've told me they can do something that I can't do, which is examine you internally. They tell me when they ask their clients when they come in, can you do a kegle for me? That one in three patients are bearing down, not lifting up. So in that person's mind, they feel the sensation of it moving and in their mind it's reversed. They think they're lifting up and they're actually bearing down. So let's say you're doing, oh, the doctor told me to do 100 kg goals a day and you aren't doing it right. You're gonna again you could maybe be bearing down. You're doing it wrong. Maybe you're already hypertonic and you went to a doctor and told them that you had incontinence and they say, "Oh, we'll do 100 kgles a day." Okay. So, like I just can we stop with the kegles? Uh I [laughter] wanna I want to give Dr. Kaggel some credit that I mean he was even talking about it. It does somewhat irritate me that we're that we're naming something for the female body after a guy, right? That's it irritating. My husband said, "Well, maybe he named it after his wife," which I thought was a [laughter] but but like kaggles are just this ve really vague thing and as you implied that it's, you know, what is it? Is it we're on the toilet and squeezing as hard as we can? That is a bad thing to do. You know, peeing and pooping should be an act of actually relaxing enough to release everything. So, the last thing you want to do is feel like you have to pee and before you're going to pee, you're going to or midstream. I've heard that uh >> midstream stop your stream. That is not good for your brain bladder connection.

[00:35:05]Really bad. So, you know, a lot of my work is the beginning of it. There's a lot of subtlety. You have to tune in on this level that you may never have have tuned into. Like you have to feel that the pelvic floor again I described it the muscles basically are are um strung from front to back and side to side. So think of a diamond shape. Those muscles you need to feel the front, the back, the side and the middle. Right? So, if you're just kaggling your day away, but you're not really tuning into what you're doing, you might just be like making your glutes tighter. [snorts] You might might not your pelvic floor might be like, I don't know what you're even talking about. [laughter] You know, as you say that, I'm like sitting here thinking that's me. My pelvic floor as you're even talking, it's like, wait, what? Diamond shape.

[00:36:03]>> [laughter] >> I'm like this is this is just mindblowing and I think look mind blown for you listeners and viewers right please I mean you this is such a great takeaway from this interview kaggels were created or the term by Dr. Kaggel and we're probably doing it all completely wrong or we're doing it in a way that is absolutely not helpful for your individual condition. I know that it's very difficult for you on a podcast or or a YouTube video uh Leslie to actually for you to teach this but so I am going to say um ladies in Leslie's book pelvic liberation she has very deta a very detailed um work yoga practices for for whether you are u hypotonic or or hypo and and They're different. They are different exercises and they're different poses.

[00:37:02]And as somebody who has taught yoga for many, many years, again, mind blown, had absolutely no idea, is not taught in the yoga community at all. Um, and in fact, some very odd things are taught in the yoga community. These very, and you go into that quite a lot in your book, all the various different sort of locks and moola bundas and things like that, which I think is confusing anyway for for anybody most of the time. how how that is taught. I don't want to go too much into the weeds on that, but suffice to say for all of you watching and listening, do yourself a favor and get and get the book because you've been so generous in your explanations in the book and there are really wonderful line drawings as well. Um, showing you exactly the position to get into what I was trying I was doing them over the weekend actually. Um, and and and it's lovely. I mean it's really relaxing and you're using the breath and it just feels like you are caring for this area of your body. You're putting the attention. You're becoming conscious and aware. You're feeling into the sensations. I think so much of the sort of entrylevel work into into what we're doing here Leslie is bringing awareness into your this part of your body. I mean sometimes as you know with yoga my pet peeve with yoga is just I mean preaching to the choir here but what it has become all of the sort of flow yoga and hot yoga and doing all that and and so far away from the sort of deep internal awareness and consciousness of what is what is what is going on. So all all this to say, I just wanted to say to everybody if you're thinking, "Oh, I just so want to have some direction on how to start even getting into this and doing some of these exercises," it's all going to be in that book. Leslie, I want to just pivot back for a moment because I think this might be very useful for the listener and the viewer. And and I noticed the first time we spoke about this, if you're not watching on YouTube, Leslie was sort of doing she was showing with her hands these different the the diaphragm and and the um pelvic floor breathing. But the thing one of the things another mindblowing thing that I got from your book was I I teach a lot of of of breathing, but I I I very rarely relate it to the pelvic floor because I just didn't have that knowledge. And so what fascinated me was was the connection that you spoke about about these two and you speak beautifully about it in the book these two muscles the diaphragm and I'm very familiar with diaphragmatic breathing and the pelvic floor of how they are very very similar um in in they're these two very large muscle groups. Um, could you take us through putting you on the spot here a little bit, but could you take us through a little breathing exercise or some kind of awareness that you can actually have us in real time now connect to breathing in and what we could or should be feeling in our diaphragm and in our pelvic floor on the on the inhale and the exhale.

[00:40:22]I will do my best and thank you for reminding me that not everybody can see me. [laughter] Um, yeah, I was using my hands so I apologize. Um, >> okay. So, I'm gonna assume that most people are seated and so if you're driving, you're not going to do this.

[00:40:41][laughter] And if you're at work and there's people around, you're also not going to do this. Okay? But if you're by yourself or you feel comfortable with where you are, >> [snorts] >> um, first thing I want you to make sure is that you're on your sitting bones.

[00:40:54]And those are those little bones at the bottom of the buttock. They're a little more internal to the buttock. Um, but a lot of us, if you are someone who kind of tends to slouch, then you're probably sitting more on your tail than your sitting bones. And then there's some people that tend to kind of push their rib cage forward a little bit too much.

[00:41:14]their belly is a little pushed forward.

[00:41:17]Um, then you might be too forward on the sitting bones. And so I'm going to give you that like nuanced instruction of can you be right on the center of them. And then I want you to think about so the center of the pelvic floor is directly between the two sitting bones. Directly center of the two sitting bones. Okay?

[00:41:37]So that's called the paranium the central and the the also the most central. And if it's not damaged through scar tissue, uh is the strongest part of the pelvic floor. Um that area like the respiratory diaphragm as we inhale it should move slightly down and as we exhale it should move slightly up. But let's start with something really simple. Put your place your hands on your lower belly right below the navl.

[00:42:06]And then just where your hand is resting, just take a few deep breaths and direct your breath to to touch your hand even more. So that as you inhale, your bell is coming into your hand and as you exhale, it's slightly moving away from here. Right? So that's relatively accessible.

[00:42:25]I will mention that if you feel like you want to do the opposite here, you are a reverse breather, which I talked about earlier and you need to work on that because it's important to get rid of that pattern. Okay. Now, let's take our two hands. I'm going to fold my hands um so that the back of my knuckles so I can put them against my side lower ribs where the respiratory diaphragm is. So, I have them on the left and the right, left hand on the left, right hand on the right. And now can you think about breathing into your two hands here? So now your breath is going wider instead of forward into your belly and just see that you can feel that.

[00:43:08]So you're noticing that as you inhale your hands are moving away from each other and as you exhale they're releasing towards each other. Okay. So just a general idea of the belly. When you had your on your belly, your belly came forward as you inhale and it retreated a little bit on the exhale. So I want you to think about the whole body in this way that as we inhale it actually expands a little bit and as we exhale it contracts a little bit. So now if you again if you're in a place where you feel like you can do this, you're going to put one finger on the crown of your head and the other finger on the paranneeium which is between the anus and the genitals. And make sure you're on the center of your sitting bone. You can't be a rounded back here. And now close your eyes and feel see if you can feel this. As you inhale the paranium and the crown actually move away from each other. And as you exhale, they move towards each other. So as we inhale, if you can um picture an accordion, it moves out. As you inhale, taking the air in. And as you exhale, they release towards each other. So if you have your finger on the paranneeium, like really pushing into it a little bit, you can probably feel that there's a little bit of movement there. So that would be like a just a very basic way to get a little bit more in touch with this area is to feel that the verticality. So our breath does this. It does this. Um again I'm using my hands. So it goes it goes uh it makes us grow sideways a little wider and then narrow as we exhale. Front and back move in and out as we inhale.

[00:44:56]Exhale. Top and bottom move in and out as we inhale. Exhale. So, um I don't know Sophie if you could feel that, but um >> yeah, I could. That was enormously helpful. And I've never done I done worked a lot with belly breathing and diaphragmatic breathing, but it's putting all of that together. And I found it incredibly helpful to do that last piece. And that's something I will never forget that that that putting one hand on the finger on the crown of the head and the other on the peraneium because it's very very easy to remember you know that lengthening. Um and that that that was be beautiful. Thank you so much for taking us through that Leslie.

[00:45:37]Leslie, just to finish out here um is this takes me to this last um question which is which you're already showing us how to do is developing a relationship with this part of our self. Um, I think it's the favorite my favorite part of your entire book was you talk about developing a loving relationship with your pelvis.

[00:46:05]And it sounds simple and obvious, but when you read it in your book, it brings up up a lot of emotion actually and it's really beautiful and really profound. So could you just talk very briefly about in developing a loving relationship with with you with your pelvis for the for the listener and the viewer? What what does it mean? Where where would you encourage women to begin if they have felt disconnected, ashamed, frightened or frustrated with this part of themselves?

[00:46:39]>> Okay, again a giant question. Um, okay.

[00:46:43]So, I get a fair amount of women, you know, a percentage of women at my workshops. And I say women because it's usually generally mostly women. I don't usually let men in. Um, that say they don't want to do the like I describe how to do an internal massage and they don't want to do that or you know they have so much pain they're afraid to do it. Um so first thing is to so you you need to dial whatever it is you can't do it or feels uncomfortable you need to dial it back to what you can do. So like we just had our hand on our belly breathing it might have to start there.

[00:47:24]The next step is put your hand on your your pelvic floor and and just rest it there and see if you're okay with that because some people that stage just that stage might take some some time. What you want to be able to do is be able to take a deep breath with every stage.

[00:47:44]Okay. So that so that's just more like the physical like being com a little more comfortable with the physical. Um, in my book I say, um, every pelvis has a story. And, um, not until, you know, I ended up with a lot of pelvic pain did I try to look at it with that lens of what if my pelvis could tell the story >> of of itself? Like, what would that be like? And I sat down and I wrote pages and pages and sadly pages >> of things of, you know, like inappropriate sexual things that happened uh to me. Um, you know, I had a lot of UTI, um, yeast infections. Um, but like I didn't see the connection. I was a young person who like I wasn't a yoga teacher.

[00:48:36]I wasn't into mind body stuff at all. I didn't see any connection in all this stuff. Um, so writing down um the story of your pelvis, if you're up for that, um, and I don't want to I don't want to disclude great things that happened to your pelvis, like maybe you discovered sex AND YOU'RE LIKE, "WOW, this is great." You should include that. But include, you know, surgeries. Um, >> you know, I I I really think just being female in our culture is hard. you are hit with messages that you're supposed to be pretty, you're supposed to be your belly is supposed to be flat, you know, uh I mean, you're supposed to do it all.

[00:49:18]You're supposed to like be a great mom and have a great career and I mean it's just impos it's these impossible impossible things that we are completely brainwashed like we you're we're swimming in it so deeply we don't even know how deep. Like that's how I feel about it cuz I just keep seeing layers and layers and layers of it.

[00:49:39]>> Now um you know with sexual abuse which is definitely some of my story.

[00:49:44]>> I would encourage you to also have a therapist. Okay. Yeah. Um, you know, you some people, you know, you can do you already have a therapist and maybe you work on this piece of it, but like if you have a lot of trauma in your background, particularly sexual uh sexual abuse, you you might want to have a therapist support you through this process.

[00:50:04]>> But the goal is you should be able to touch your own body without feeling like it's wrong, bad, dirty, scary. Okay, that's what we would ideally like. What I'm trying to teach is agency. I want you to have agency over your own body.

[00:50:22]So, those are a couple of things that I would um encourage people to do.

[00:50:27]>> That is beautiful. What a great place to land this interview is having agency over your own body. And ladies, I would encourage you to do some of that journaling work cuz that could be some of the most powerful powerful work. I think that's just as you were speaking I was thinking I had an apesiotomy after I gave birth you know um and it was so dramatic and unexpected to have that part of my body cut and stitched and be in pain really bad pain for any women who have you know so we've all got our things that I've never really paid the same attention to other areas that I go into and coach on and different areas of shame. It's it is time to have that conversation and and and and and time to lean into this beautiful powerful part of us. I'm not even going to say our body because it is us, isn't it? It is it is who we are. Um and so Oh, what an incredible incredible conversation. Just I was I was showing you Leslie just before our conversation a couple of things I was saying what about because I often talk about things like obviously nutrition is a really big part and hydration. I was thinking my goodness having being very very well hydrated. I'm drinking my water and I often talk about eating your water. So eating foods that are very very waterfilled much more so I think we need after menopause to eat our fruits and our vegetables that are so full of water and and and and crunch and alive. And then there's one a couple of things that I found that help um is is using uh certainly for um vaginal atrophy is using maybe a cream. Go be afraid to go to talk to your OB/GYN about your options, ladies. and hopefully an OB/GYN who can be incredibly understanding things like I use um an estrial cream uh topically. Um and that could be a way also because when you're applying that that's a way also where you're sort of befriending that part of your body as well. So that could be very useful.

[00:52:42]There's also I was telling Leslie before the interview something that I came across recently is something called it's a red light therapy and it's a device called Joy Lux red light intimate wellness device. Just check it out ladies. I'll put a link. It's kind of interesting um for you. There's all sorts of things aren't there like dilators Leslie that we spoke about briefly. um different different treatments and therapies, but I actually I have used this V Fit Joy thing and and found it to be incredibly helpful. And it was interesting because it came across my desk at the same time that you and I started having a conversation. I was reading your book. So all of these things are sort of coming together now in in in my world. Um Leslie, is there anything that we that you didn't say on this during this interview? Is there anything that was unsaid that you didn't say that you would like to either tell my viewers and and and listeners or that you would like to leave everybody with?

[00:53:51][snorts] >> Uh well, we did cover a lot of territory, but you know, I do run a 20our training for yoga teachers. So there's also a lot said um I nothing specifically I want to maybe encapsulate some of the stuff that I said like I just to again think about I also thought after my the last piece of like things you can do to develop a relationship like you know the story of your pelvis is it was really helpful to me um you don't have to do this but I showed okay so I was having pelvic pain, having penetrative sex was challenging or non-existent.

[00:54:34]>> Yeah.

[00:54:34]>> And um I shared the story of my pelvis with my husband and he was like, "Wow."

[00:54:42]He's like, "I had no idea all this stuff happened to you." Um and that what that did, okay, it made our relationship better. Like I felt like I think there was a part of him that thought maybe I just didn't want to have sex with him. Um, but also I reframed it with that story as like if I had a friend telling me this stuff, I would be so tender and compassionate with my friend, but we're not that way with ourselves.

[00:55:11]>> Yeah.

[00:55:11]>> Know a lot of you out there can relate to that. Um, yeah. So that so so if you decide to write down your story even just think about it can you reframe it that your you know your best friend's telling you that they've been through all this and then like h how would you react? Can you can you love yourself that much? Um that is a real challenge for a lot of throwing myself in there.

[00:55:35]Um so there's that. Um do not underestimate the power of good breathing. Okay. So many of us pull our bellies in when we inhale. That is not the most efficient way of breathing.

[00:55:53]Okay. So, what I love about looking at the pelvic floor through a yoga lens is it's again super integrative. So, it's look at your life, look at what you've done, look what's been happened to you, look at your breath. Your breath actually I say this all the time that your breath is like a fingerprint. like your breath pattern is like a fingerprint and they recently proved that which I just think it mindblowing.

[00:56:18]There just was a study on it saying that your breath pattern is as individual as a fingerprint. Wow, >> that just blew my mind. So to become a better breather um that that is the single most important thing you can do for your pelvic health because if you're doing that reverse breathing pulling your you take a deep breath in and pull your stomach in kind of like military style you're you're queuing your pelvic floor to lift as you inhale and that is not what it should be doing. So um so those I think are the two most important things um is better relationship with your self-t talk um uh reframing it and and better breathing.

[00:56:59][clears throat] >> Oh you're incredible. What a gift you are. What a gift you are Leslie in your work. And you know, you've you've always say, you know, I want to I I want to bring people onto this podcast who've done their 10,000 hours, you know, in terms of expertise because there's many that haven't, as we know, they've done a quick weekend course in breathing or something. [laughter] And and I I'm I'm I'm interested in in in having women like you who you've put in more than your 10,000 hours. And thank you for sharing that very intimate part of your own story um with us. And you you're absolutely right. The the the deeper work that I do is is about um really ultimately learning to love ourselves on a deeper level because we all most of us carry so much shame and we talk to ourselves not in the way that we would talk to a loving friend. And for those of you, you know, who who are listening, if you are having trouble and you're really struggling with shame and not loving yourself and putting all these pieces together, you are welcome.

[00:58:07]As usual, I'll drop a link in the description that you can book a breakthrough session with me. Um, and I'll put it on the podcast page as well and we can really get into the full picture of really what you're struggling with and and and what's um, you know, and where you want to go and see if I can help you further. But Leslie, I want to finish with this. Um, so go out everybody and get Leslie's book. Um, and again, I will put details of where you can buy it. Um, the pelvic liberation.

[00:58:38]Um, start there because all of these exercises and everything that Leslie has spoken about is in detail in this book.

[00:58:46]Every woman needs to own a copy of this book. And I mean every single woman. I would I I I'm purchasing them for my friends. Um I think ladies, you want to purchase them for your daughters, your your you know, anybody who you know because if I had had this many many years ago, um I would have been um in a better position. Um so go and get the book. Um I'll also pop details to where you can reach Leslie. Um possibly do any of her courses. If you're a yoga teacher, you might be interested in one of her teacher trainings as well because that's something that I would think would be wonderful for every single yoga teacher to to um to learn how to teach.

[00:59:28]We need more Leslie Howards in the world for sure. And there's [laughter] only there's only one.

[00:59:33]>> I'm sure my husband would agree, but >> there really is that we need to have a a lot more Leslie Howards. Um thank you so much for coming on. Thank you so much for giving us your your your precious precious time and um we're going to have you back on because I feel like we've just touched on such surface surface details that we've managed to do in in in one hour. So we'll have you back on and maybe we'll just delve into one particular topic and really do a really really deep dive on on that.

[01:00:06]>> I love that and want to thank you for your enthusiasm. [laughter] It really means the world to me um that my book has touched you that deeply. Seriously, it's really makes me feel >> Well, it has. And sometimes we write the I mean, as you know, I've written books and you never know when it's going to be uh when it's going to touch somebody and reach somebody. And I also think so often um you know, we we we only hear about the latest books that are coming out. And I honestly am now finding more and more that going back into a deep library of authors who have done this in had this enormous body of work and done their 10,000 hours. That's where um sometimes the real value is and it's no exception with your incredible book. So thank you. Thank you and we will see you next time. Bye. Bye-bye.