62: Un-Normalizing Maternal Incontinence with Pauli Hannan (you don’t have to pee when you sneeze, and Kegels aren’t the solution!)

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Hey mama, let’s unnormalize peeing your pants a little when you sneeze. If you’re out of the loop like me, you just found out that incontinence of any kind (even a little bit) isn’t okay and Kegels are NOT the answer. So, what the heck are we supposed to do then? 

Today I am joined by Pauli Hannan from Beyond the V, she’s a mom who understands that you don’t have a ton of time or energy to start some strict, confining regimen to fix this issue, she also knows what she’s talking about since she’s been a pelvic floor physical therapist for 12 years! 

Pauli is sharing with us the deets on knowing if you need to work on your pelvic floor (if you’ve ever birthed a child, this is probably for you), and simple solutions that work. Let’s heal this together and unnormalize maternal incontinence!

Interview with Pauli Hannan from Beyond the V Podcast

Brittni: Hello my friends. Welcome to another episode of Meant to Bloom. Today I have a special guest on it is Pauli from Beyond the V. She is a phy, she’s a pelvic floor physical therapist. I knew I was gonna mess that up, and she’s here to talk to us about our pelvic floors and some very simple solutions. So, Pauli, would you like to introduce yourself a little?

Pauli: Of course. Yeah. Thank you. Like you said, Brittni, my name is Pauli. I am a pelvic floor physical therapist. I have been practicing as one for over 12 years, and about a year and a half ago, I decided I wanted to open up my own space because I just felt like women needed to be treated a little bit differently.

And so here we are. And then last March I launched my online brand, No Kegels University, because one of my passions is making sure that women know that they have options. So they don’t need to continue to, and I hate to use the word suffer, but to to suffer and to struggle with things. That, that come with having children or come with having a pelvic floor that might experience some trauma or damage, if you will.

And just assuming that it’s okay to live in such a burdensome way when there really are answers. And so, I, one of the things I love talking about is the pelvic floor, which I realize not everyone always feels comfortable with, and while to me the pelvic floor is a muscle just like our bicep or our quad or anything of that nature, I do realize that.

Those muscles are covered up and we don’t typically talk about them. But I also think that there needs to be a place in space where we can discuss these things, but of course, do it in a conservative way and a respectful way, and of course, giving dignity to whomever it is that we’re discussing. But that, that’s me, and that is my passion, and that is what I spend a lot of my time doing.

Besides being a mother to two children and our three dogs and our chickens.

B: Oh my gosh. I love that. I can like your positive energy and like your passion for this. Cool. That is incredible. Okay, so that kind of leads me in. You touched on some things there. How does a woman know that she needs to fix something in her pelvic floor?

Because I think that we become moms and we just think it’s super normal that every time we sneeze, we’re gonna pee a little bit. Or no, we can’t jump on the trampoline because we’re gonna pee a little bit. What is normal and what should we, you know, draw a line and say, I don’t accept this anymore. I can, we can do better.

P: Yeah. And I really love how you said like, where do we draw the line? Like what’s acceptable and not. So generally speaking, my first out of the gate response is if you’ve had a baby and you’ve torn or had an episiotomy or had a C-section, I think in my opinion, I think that’s an immediate reason to go in, and see somebody like me.

Because there’s now scar tissue, and scar tissue doesn’t always stay local. It can inhibit how those muscles work. So as you are given permission at the six week time period, okay, well now you can go exercise, but technically that scar isn’t healed all the way. And if you don’t have a specific protocol to help you return, that’s where a lot of problems show up.

And I’ll see people, you know, six, seven years down the road. That never got help back then. And not that I’m trying to be negative about this topic, but if you, if, if any of your listeners have had a surgery before or a loved one, you know that more than likely they went to physical therapy and there was this protocol that zero to two weeks you were doing these things and you had to reach these particular milestones before you could go on to the next phase.

And then during this particular phase, you know, maybe two to four weeks you’re working on these particular things and you have to reach this milestone before you can move on to the next and. You, I kind of hinted at this already, you know, you’re just given six weeks, go ahead and everything is fair game and I just don’t think that the body heals that way.

So, that’s what I would say generally, but more specifically, like you mentioned, incontinence of any kind, should not be acceptable. That’s our body’s way of telling us, even though we may not see it that way, that those muscles are not strong enough and they’re failing us. So I’ll liken that to if you went to stand up out of a chair and maybe every fifth or 10th time your knee gave out, especially when you’re like running around with a baby or something or a kiddo, you might kind of start to worry because you know, oh, my muscles should be helping me stand up, but they’re failing me every so often.

It’s the same message when our pelvic floor is not doing its job to help maintain. Our incontinence or us not leaking urine and a couple of other small, well, maybe just more vague options that you might consider, if you are having a hard time returning back to exercise after having a baby. Again, there’s so many factors that go into that, and I don’t wanna take all the time to discuss them all.

We grew a baby for nine months, our body is not the same. And so to assume that the six week mark with all of our hormones that still make everything loosey goosey up to nine months after having a baby, there’s a lot of considerations and factors that aren’t always. Present in our decision making as we start to return to exercise.

So I think if you’re having a hard time returning, that’s a really good one. If you’re worried about diastasis recti or diastasis recti, however you wanna say that, if intimacy is painful, should never be painful, that would be a great reason to go see somebody,and then I would just say general back pain, pelvic pain, hip pain.

Again, because there’s so many changes. I think it’s important to ensure that the body is given at least a good once over by somebody who knows something about the body in order to ensure that you’re able to return to activity and to be able to keep up with your kids and, you know, with your husband and do the activities that you, that you want to do.

B: Oh my goodness. Yes. That’s so good. I. I think that we get in this mindset, like this mentality as women, like after we’ve had a baby, we’re just like, okay, right back to it. I can do anything. Like I’m a superhero. And like there is so much like it’s one of the most traumatic experiences to the body.

Like you feel like you’re dying at one point and then all of a sudden you’re just like, okay, we’re gonna go right back into everything as fast as we can and not take all this time off like, actually we need, we really need to rebuild and repair here. 

P: Agreed. Agreed. Absolutely. Yeah. 

B: And I mean, personally, like I didn’t know any of this with my firstborn.

So, I mean, we’re talking six years later and I’m thinking, you’ve brought up a lot of points. Like I should have seen somebody and nobody told me like, Hey, this happened to you and you need to go have this looked at, I’m highly recommending it. Like I know I had access to it, but nobody was like, this specifically was a reason to go.

They were like, if you feel like you need to go, then go, but nobody clarified. What are the signs, what are these small things that happen to you that are a reason to go? So I think a lot of women out there might just like be having their eyes open right now. Like, that was more serious than I thought. That shouldn’t be happening. 

P: Oh yeah, I just, I cannot agree with you more on that. It’s standard in Europe, so after you have a baby over there, you are referred to a, I think they call, they go by physiotherapist over there, but a pelvic or physiotherapist, it’s just standard.

And just to even add a little bit, one thing I come up against a lot, whether it’s potential patients or clients in the DMs. A lot of women, I don’t think that they, it’s kind of a subconscious thing. They may not even feel like they deserve it. I think just because of the narrative around being a mother that you just kind of throw your hands up in the air and give up.

I would even go as far to say as you deserve it, because I get to be on the receiving end. I think in the sense of when a patient walks in, while I love working with people online, I like seeing the in-person change as well, but when somebody walks in, I, they don’t always look this way, but they’re sad, they’re emotional, they’re frustrated, even present as hopeless. And by the time they’re done, it’s incredible to me to like watch, watch the change from when they first came in to their last visit and they, they just have so much more energy and hope and their mindset has shifted because we’ve been able to take one thing that’s kind of burdened them, if you will, over a period of time and get rid of it so they can go onto the next thing or just even.

The day to day of being a mom and wiping bums and making lunches and doing laundry and keeping the house clean. It’s one of those things I think all women deserve it. I’d be so bold to say that.

B: Absolutely. Oh my goodness. Yes. And I’m sitting here thinking about this now, like we make so many decisions in a day and I think that we don’t realize. When you have to like mentally prepare for an activity questioning, do I need to go to the bathroom before I do that? Is this potentially gonna make me pee my pants? Like we think that maybe we don’t have time to work on our pelvic floor, but it’s like you really don’t have the time and energy to be constantly stressed out about this on the back burner.

P: Great point.

B: Yeah, and I think that’s probably something that you’re really seeing with these women when they get this fixed. It’s just like mentally. It’s opening you up to not have that stress. Yeah. And to not have to worry about it. You’re just like, wow, a problem was solved, , and now I have like all this extra like energy and like room for thought.

P: Yes. You’re so right. I’m so glad that you brought that point up. 

B: Oh yeah. I think it’s a lot of the same thing. So many things just clutter up in our brains. And we’re thinking about so many things, so many decisions. And then like all the things like that come into my whole podcast is, you know, talking about like, Decluttering and letting go of all the things you don’t actually need to be doing, and starting to get mindful about all the things in your life, the decisions you’re making, the things you’re doing.

And this was something that until I’m talking to you right now, it didn’t occur to me how big of a deal this is. I am so glad you’re here on my show today, talking about this. It’s not just whether you’re gonna pee your pants or not. This is a big deal. This is like part of your life. It’s your everyday, like your quality of life.

P: Mm-hmm. Absolutely.

B: Okay, so how can we make this as simple as possible? What is the first thing, simple solutions? Cause kegels are out. Yeah. Yes. We’re not doing kegels anymore. 

P: That’s right. That’s right. 

B: Where do we start? What do we do? 

P: Sure. So I’m glad you asked that and I loved how you said simple because that’s a lot of my programming and I think what, it wasn’t until I became a mother that my programming change to reflect that, cuz I thought, oh yeah, if I can combine something that I’m doing with the kids already, Then it’s not as hard or if I can make it appear as though it’s like play, they have no idea.

So a lot of the times, the stuff that I’m doing to strengthen my pelvic floor, it’s either when I’m working out or I disguise it as, like let’s turn on some music and have a dance party. And they have no idea that I’m doing my quote unquote exercises. And so it’s kind of a win-win for everybody.

And I don’t, I know they say that multitasking is, It’s not in anymore. It’s not the most effective or efficient. But I also think that if you can kill two birds with one stone, then I really like that. So one of the way in which I structure all of my programming for my patients, I’ve termed it VAB3

What that stands for is vertical, above, below in all three planes. So, believe it or not, it’ll make sense when I say it this way, but our pelvic floor works anytime we have that up and down motion, right? So when we sneeze or jump or laugh, it’s not the upward or the, it’s the two or the, that downward motion, the pelvic floor should contract in response to that.

So that’s what’s happening normally. That’s what’s happening physiological. We use that to our benefit. A is for above. So as that relates to your core, as that relates to your breath, as it relates to your spine mobility, those are important components and concepts that we incorporate. 

So, B is below. What we’ve seen in the research is that anything that our hip does or doesn’t do, it decides what our pelvic floor does or doesn’t. So case in point, a lot of the times our pelvic floor isn’t great after we have kids. Not always because we’ve torn or had had an episiotomy, but when we turn our toes out and do that, stereotypical waddle, we’re actually turning off our bum muscles and giving permission to our pelvic floor to turn off.

So it’s not necessarily your fault for having a baby and now you leak, it’s because that hip isn’t working. So I like to use a lot of leg things in the programming that we do. And then 3, is all three plans. Without getting into it too much, we’re 3D people living in a 3D world. Our pelvic floor is the only set of muscles that have fibers that run in all three planes.

And so I like to utilize that principle in my programming. So what I’ll tell people is pick two from the VAB three and go from there. So I loved how you said it very simple. So I already said like turning on music, and dancing with your kids, cuz all our kids wanna do is spend time with us.

Well, At least mine do anyways. And so by turning on music they like, they’re having a good time. So I’ll make sure that I’m doing some vertical things and I might kind of jump, jump in place. I might jump around different sides. So, and maybe I didn’t say this, ‘all three planes’ is anything front to back, side to side, or anything diagonal and rotational.

So as I’m jumping around, I’m trying to consciously make sure I’m jumping in all the directions. Maybe I might add some squats and change my foot position and the kids have no idea. And then I can easily say, well, I picked two things. I picked vertical and I picked all three planes, and maybe there was a little bit of B for below in there.

Or one thing I really love is the trampoline, which I know people fear quite a bit, but even if you’re out there just gently bouncing, pretend you like – I don’t want to, you know, throw any grandmas under the bus – but think about like, what would your sweet grandma do if she was on the trampoline?

She would bounce very gently. But that’s another great way to still work your pelvic floor, but also be in the presence of your kids and have a great time. A lot of things can be done. I like to think of the, you know, the microwave method or the boiling water method or just, oh gosh, I just have a couple minutes to kill.

I don’t really know what to do. Those tiny little moments or even brushing your teeth or washing your face. Again, not multitasking, but, kill two birds with one stone. If you can do that and then incorporate whether you are doing squats. 

One of my favorite ways to incorporate the VAB3, I like to call it the squat and clock reach.

So think of there’s a clock on a big old clock, like a mural on your wall, and then as you squat down, you’re gonna reach overhead, like you’re gonna hit the. And then stand back up. Put your arm back down, and then as you squat again, reach to the one o’clock and then stand back up. And you’ll repeat this all the way to the three.

And then that right arm is gonna reach across your body to 11, 10, and nine. Do the same thing with the left side. And then you can even take that same idea and say that the, you know, the top half of the clock is painted on the floor, and then you’re reaching out to that number. On the floor, if you will.

And so it creates different angles and it creates the above principle, but then it also has the B or below. And so you’re really, it’s not that hard to throw a few of those in there, especially while you’re brushing your teeth. So those are some of my favorite ways to add in where it’s not a production, if you will.

B: Mm-hmm. Right. Oh my gosh, I love these. This is very eye opening. And one thing that I did not, it didn’t occur to me, and I don’t know why I feel silly for not thinking of it before, but I mean, just think of so many things in a day. Of course, I think of everything so, but basically doing the actions that make you nervous that you’re gonna pee yourself, that’s what’s going to help build the muscle to not pee yourself? 

P: Right. And I maybe the one point I didn’t throw in there, cuz I, I’m kind of sensing like, I could see some of your listeners, like, was this girl crazy? What I should have said was, you’re only doing it. Before your threshold, so I don’t want, while you’re doing this, so if you have to pull back your effort, and that’s why I suggested think about what your sweet grandma or grandpa might be doing on the trampoline with you, or if they were there, pull it back to an intensity that your body can handle because then we know your, your, your pelvic floor isn’t failing you.

If you’re not leaking or having pressure. You know, it causes a prolapse or something, but you are. Letting those muscles do their job. And hopefully you’re giving your brain some evidence that, hey, like we can do some of this at a lesser level to start. But eventually you can, you can build up from there.

B: All right. I love that. That is super helpful. If you didn’t have any, did you have more to add on? 

P: I really could go on forever. I like the idea of simple, which is one of the reasons I’m a fan of what you do, because as moms, we need simple, we need doable, we need actionable, and so that’s typically where I have people start from there because I would rather you be successful with something than have so much information and try to figure out where to go from there. Just do what you can do and get really good at that before you go on to that next thing or add more. 

B: Yeah. Okay. I love that. Yes. This keeps it very, That is like super simple to add some simple things in like that. You mentioned the microwave method and the boiling water method.

So that’s just when you put something in the microwave or you’re starting to boil water, you take those minutes and fill that with the movement.

P: Yep.

B: I love everything that you’ve brought to my show today. Thank you so much for being here. 

P: Oh yeah, of course. 

B: Where can I send my listeners to connect with you more?

P: Oh, sure, so I’m on Instagram @BeyondtheV.bypauli. I have a YouTube channel and that’s more discussion on pain with intimacy. That what a lot of those are. There’s a couple on there about more pelvic floor ideas and principles, and I have a podcast as well Beyond The V, that you can find on Spotify in most, I guess streaming platforms and if I can help in any way or direct anyone, I’m not, I don’t necessarily like wanna shove any of my services or products, you know, in anything spaces, but my online brand is No Kegels University.

And like I said in the beginning, I’ve always dreamed that every woman should have the chance to have access to these things. And not everyone has the time or the finances to necessarily go and see somebody like me in person. And I just, I thought that was dumb and stupid and ridiculous, and I wanted to change that.

And that’s what No Kegels University is, there are courses there for most women’s health diagnoses. So if you wanted extra help or even trying to determine what might be a good fit, I am more than happy to help you walk through that process and kind of hold your hand to help you determine what might be best.

But at the end of the day, I’m hopeful that the stuff we talked about here might just even shine a light on what you’re experiencing, and hopefully you feel validated that you are not the only one experiencing this and that the rest of your life doesn’t have to look this way. Like, let this be an opportunity to remove a burden from your plate or a stressor or a decision like you said earlier.

Let this be an opportunity for you to get rid of that so you can maybe add something that you wanna do or tackle the project you’ve wanted to. It really doesn’t have to be this way, especially when there are options. 

B: Yeah. Thank you so much. I love your passion, your excitement, and so much knowledge in there too.

My brain’s gonna explode. Thank you so much for being here. 

P: Of course,

B: I will include your links in the show description so all my listeners can go ahead and find you everywhere. So thank you so much for being here. 

P: Of course, of course.