Jen (00:01.358)
Taryn, welcome to the Mumsafe Movement podcast. How are you?
Taryn - FitRight Women's Health (00:05.721)
I'm good. How are you?
Jen (00:07.726)
I'm good. It's funny. We just had this whole conversation and like when you go, how are you and someone says I'm good. It's like, really? Is that the actual thing? It's like when you just say, yeah, I'm good in the straight walking past them. I'll be honest when you said, how am I my life feels like a roller coaster at the moment. We're dealing with a lot of stuff around a not so very small human. She's only 13, but I do not know what's coming to me on a daily basis at the moment. So yesterday,
Taryn - FitRight Women's Health (00:18.873)
Go away.
Jen (00:36.27)
I would have cried and today I've like got all this energy and I'm just rolling with it. So.
Taryn - FitRight Women's Health (00:40.921)
Yes, I know. It's such a roller coaster and the way that like the same things can be thrown at you, but depending on what like where your body and I don't know your hormones and everything are depends on how how you react to that. And you have you have the 13 year old daughter. I have a four year old daughter who I feel like is the thing. I don't know what's going to get thrown at me each day.
Jen (01:02.798)
Yes, very, very fun. Sending lots of love to anyone else that can relate to the ups and downs of parenthood or motherhood. Taryn, thank you for being with us today. I appreciate you taking time out of your world. Can you, to kick us off, share with us a word around how you're showing up today? A win and then also something that you're working on.
Taryn - FitRight Women's Health (01:10.945)
Mm -hmm.
Taryn - FitRight Women's Health (01:25.465)
Okay, all right, so to be completely honest my word when you said that was meh. My word is that today I am not... my word of the day today is not one of those days where I'm feeling like I've got that happy energy, can take on anything. And yet two days ago if you had have asked me I did feel... I think my word would have been like, you know...
positive, like excited. I told you I'm going to Sydney by myself without the kids this weekend and I'm like I should be excited but yeah to be honest my word is Blair.
Jen (01:59.854)
So exciting.
Jen (02:05.006)
Blur. We'll roll with that. And yesterday I would have been blur or you might have asked me how I was and I might have just cried at you. So just, Taryn, what are you winning at?
Taryn - FitRight Women's Health (02:13.529)
Thank you.
I am winning at what's happening in my clinic life at the moment. My win is going to work on my clinic days and seeing the outcome of what has been in my head for more than a decade and seeing that in practice and walking into the clinic on a clinic day and seeing the different health professionals there and...
Jen (02:22.51)
Okay.
Taryn - FitRight Women's Health (02:44.665)
getting to interact with them and the practice manager or the receptionist and the lactation consultant and the women's health GP and the other pelvic health physios. And yeah, it really is a win, which is why my words should be a bit happier than this.
Jen (02:59.214)
All I'm hearing is the word should and there is no should in this equation. It is what it is. Yeah, yeah. I wanna know more about your clinic, but I'm gonna ask you what you're working on and then we're gonna circle back so you can tell us about how this is all eventuated over the last 10 years. And then we're gonna dive into today's real topic, which is around prolapse and pessaries and all kinds of things.
Taryn - FitRight Women's Health (03:03.577)
Yes. Yeah.
Taryn - FitRight Women's Health (03:15.257)
Yeah.
Great. What I'm working on at the moment and have been working on this morning before I got on this call is I created a pregnancy online program a while ago when I was pregnant with my daughter actually, so like five years ago. And yeah, it's kind of since the clinic launched, my online world has kind of disappeared a bit and I sort of let it peter out a bit.
And I'm working on an update of the pregnancy, I'm calling it Pregnancy Power Program. It's like education and exercise in all packaged together, the sort of things that we do in person and the education that would come up in classes over time, but all packaged together for those women who are coming to the classes, but also for the women who can't get to the classes. And kind of laying out a bit of like a gold standard of what
we would love for women to get access to from a physio and other health professional point of view through their pregnancy and setting themselves up for the best birth and recovery after. So yeah, I'm working on that program and I was writing out some of the scripts this morning.
Jen (04:30.382)
That's fantastic. And I think it's never too early for our pregnant mums to start to think about the way that they want to move through that pregnancy, but also the postpartum period, I guess. I can only imagine how awesome that program is. We might, if it's okay with you, what's the name of the program? Pregnancy Power, is that what you're calling it?
Taryn - FitRight Women's Health (04:46.809)
Yeah.
Taryn - FitRight Women's Health (04:54.169)
Yeah, I haven't said it in stone yet, it hasn't looked like it, but I think it's going to be called the Fit Right Pregnancy Power Program. Yeah.
Jen (04:57.102)
I like it. I like it.
Fantastic. We'll put a link in the notes so people, any moms that are listening can jump on into that. That would be cool. Yep. Yep.
Taryn - FitRight Women's Health (05:07.225)
fantastic. Great. Yeah, there's some really new, like exciting, updated research on the sort of things that women's health physios can assess in pregnancy. And if we pick that up early in pregnancy, we can make a difference to things like tight, overactive pelvic floor and how you when you're cued to bear down what you do and if you bear down correctly and you know, the outcomes on things like prolonged pushing in labor and
Jen (05:16.75)
Mmm.
Taryn - FitRight Women's Health (05:34.873)
the need for intervention with regards to forceps and vacuum and you know all of that sort of stuff. It's quite exciting to think that we can pick things up early and put in place but also empower that woman to then make her own decisions based on findings with regards to her birth and stuff too and as you know as you do as well you know just then implementing just not the pelvic floor but the whole body
Jen (05:45.55)
Yeah.
Taryn - FitRight Women's Health (06:03.033)
preparedness for birth and the post -natal period and setting the woman up feeling strong and empowered to know the pros and cons of what she should do with regards to exercise and moving her body and all of that. So yeah, I love, I love working with pregnant women.
Jen (06:05.102)
Yes.
Jen (06:16.75)
Yeah, nice.
Nice. And I love what you're saying about the research. And I'm just kind of thinking, where does this sit in this conversation? And it might come in a little bit later on when we think about, you know, we delve into prolapse, and then we go, well, how can we prevent prolapse? Because that's exactly where that, and we never want to say we can do it, right? But we want to go, maybe.
Taryn - FitRight Women's Health (06:37.977)
Yeah, that's so multifactorial, isn't it? But when you said about like a topic to focus on, I must admit, I was like, I love like pregnancy prep with pelvic floor and everything. And how that, yeah, but also I love the whole prolapse management and testers and stuff too. So I chose that, to be honest.
Jen (06:47.15)
Yeah.
Jen (06:54.062)
Yeah.
Jen (07:01.486)
Absolutely. Let's go down that road. And then if we've got time, we'll do we'll weave in the prevention, which is what you're talking about. And then if we don't, maybe we need a second date. Second date. Let's see how we go.
Taryn - FitRight Women's Health (07:13.133)
The second date, I like it.
Jen (07:21.454)
Taryn, give us a little bit about your background and what I'd love to get out of that is kind of where you've come from. I know that you've got your own journey with IVF, so if you want to throw that in a little bit as well, you can do. And then also this 10 year vision that has come to fruition in your clinic. So where did that start and how did you kind of get to where you are today?
Taryn - FitRight Women's Health (07:39.769)
Yeah, actually, when you say 10 year vision, it actually probably is more like almost a 20 year vision. No, I graduated from physio in the early 2000s and that's where I met my now business partner, Jess. And yeah, right from the beginning there, we both went into private practice. She went into musculoskeletal and clinical pilates and I went into
Jen (07:44.11)
Yeah, I can relate to that.
Taryn - FitRight Women's Health (08:08.921)
women's health. I worked on a maternity ward, a private maternity ward and a linked like private practice to that. And I went down the clinical pilates path too. And both of us really early on kind of talked about like women's health and exercise and how hard it was for women, especially those women that I was seeing in this private hospital setting to like find the right people all in the one place. So for example, like I was seeing a lot of women for breastfeeding issues.
But they would see me for, and I don't know if everybody listening knows that physios treat breastfeeding issues like with ultrasound for mastitis and laser for damaged nipples. But I was treating those women for that, say. And then they would need to also find, potentially find a GP to prescribe antibiotics, maybe if they had infected mastitis. But it had to be a GP who knew the updated.
recommendations for which antibiotics and how long and everything and how to test whether they definitely needed antibiotics and all of that. So they'd have to find that person separately and then we know that a lactation consultant is a really important puzzle piece and that what I was doing with laser and ultrasound was just band -aid treatment but then if that was a recurring problem, the latch and everything needed to be looked at.
But then they'd need to go find that person somewhere else. And this person has a two week old baby and they're having to go all these different people from different... Anyway, that was the first time. And I remember talking to Jess about this too, right back then. I was like, why isn't there somewhere where all of this is under the one roof? And then, yeah, then my, then my career definitely took a turn more towards the exercise side of perinatal health, because I was in this setting where we had a hydrotherapy pool.
Jen (09:36.078)
Mm -hmm.
Taryn - FitRight Women's Health (09:59.865)
And I ran aqua classes for pre and postnatal women, but I was a clinical Pilates instructor and I was like, I want to run mat Pilates classes. There's no space in a hospital setting. And so yeah, it was probably about seven or eight years into my career. So yeah, about 10 years ago that I launched the first of these mat Pilates style group classes under my own business name, FitRight. And that was like me renting a space at a hall.
And then that took off and those were really, really popular. And then that turned into me creating a training program for other physios to become FitRite instructors. And over the next few years, like at the peak, it was sort of, I think at one stage there was 20 different locations of these contracted physios running FitRite classes all around Perth. And they turned into FitRite Aqua as well and FitRite Empower, which is like not perinatal, but...
women of all ages wanting a pelvic floor friendly workout. And yeah, then it took until 2021 to come back to that clinic vision and it took COVID and it took the class business kind of imploding. And like then turn my attention back to what the original vision had been, which was a clinic.
And now we've sort of, Jess and I launched the clinic together nearly three years ago. And then we rebuilt the, well, we sort of pulled the class business over to that. And now it's a, it's a women's health clinic with women's health GP, lactation consulting, sexology, musculoskeletal physio and pelvic health physio. But it also has links to clinical exercise at
the location and then these community -based classes, which now are only in three locations instead of 20. But we run multiple, multiple fit right classes a week in those locations. So yeah, that's, that's where it's come to.
Jen (12:04.206)
It's amazing. Like it's like a, I think it's almost like every pre and postnatal trainers or instructors kind of dream to walk into a place like that. And every mother's convenience dream, like they might not have the passion behind it that we do. But I love the fact that you've got muscular skeletal in there with women's health and then the sexology as well. That's interesting.
Taryn - FitRight Women's Health (12:27.801)
Yeah, yeah, she's amazing. And because a lot of like, one of the, I guess the some of the main things we treat as women's health physios are prolapse and incontinence, but also sexual pain and dysfunction. And yeah, the we treat the physical side of that really well. But to have someone in our team who is so good at treating the other parts of that biopsychosocial approach to sexual dysfunction. Yeah, it's amazing. She.
She really does great things.
Jen (12:59.31)
amazing. And if somebody, Taryn, wants to come and find your haven of women's health support, where would they, where do they go?
Taryn - FitRight Women's Health (13:07.641)
Yes, so the we're in Perth in Applecross. So our clinic is in the Applecross village in Perth and all our clinicians do telehealth as well. Yeah, so our and did you mean like where to find us website wise or you mean like. Yeah.
Jen (13:27.15)
We can do that later, just more the physical location, because I'm sure so many women are listening going, my goodness, that sounds amazing, because it does like they walk into one place and they get looked after in every which way that they could possibly dream of. So yeah, the physical location and I've got family in Perth. So I don't know why I've not popped into your clinic as yet when I've been visiting, but I will make sure that that's on my list next time I am there.
Taryn - FitRight Women's Health (13:45.881)
Next time you're here we're going to be stopping in the Anthocross Village too.
Jen (13:52.43)
Yeah. Yes. It's not too far away from where they are. So let's dive in a little bit to prolapse. Like what even is a prolapse? Like if you were to just start at the basics.
Taryn - FitRight Women's Health (14:05.273)
Yeah, so prolapse is like the descent of a pelvic organ into the pelvis. So technically, like there's different stages of prolapse, but a prolapse that would be considered significant would be the front wall, the back wall, or the apical, the top bit, the uterus, dropping down to a point where it's bothersome to the woman. And usually that is to the opening, to within a centimeter of the opening.
which would be considered a stage two prolapse or beyond. So stage one prolapse is like when you bear down, the front wall might move down, the back wall might move down, the apex might move down, but if it's not within a centimeter of the opening, it's probably considered normal amount of movement of the vaginal walls.
Yes, so when a prolapse gets to that point where it's coming down and it can be felt near the opening of the vagina, the woman can feel it like a bulge sensation, a heaviness. It can present like a difficulty with emptying your bladder or your bowel because that pocketing of the bladder backwards or the bowel forwards can have an impact on that.
Yeah, that in a nutshell is a prolapse. And I think that the layman definition of prolapse, I think a lot of people think it's just the uterus descending. And I think people are interested to realize that the most common type of prolapse that we see is actually an anterior wall prolapse, the bladder, the urethra and the bladder dropping backwards into the vagina.
Jen (15:38.222)
Mm.
Jen (15:52.27)
Yeah, when you're talking about the stage one and the stage two, am I right that not long ago, think like the diagnosis of prolapse kind of changed from only diagnosis of prolapse when it's symptomatic? Is that? Am I on the right track or?
Taryn - FitRight Women's Health (16:08.665)
Yeah, I'm not sure if it changed necessarily like that. What I do know is that early in my career, stage one would have been, I think probably in the last few years, it's been a little bit more talked about that it's not normal to have no movement of the vaginal walls when you're bare down. You know, like that some degree of movement and laxity in the walls is normal, especially heurist women, you know, women who've had children.
but that we should really be focusing on the diagnosis when it descends lower and that it's really important that this diagnosis takes into consideration how bothered that woman is by it as well. And it's really interesting, there are some women with, so stage three prolapse is where on bearing down, the leading edge of the prolapse comes more than a centimeter outside the vagina. So, and then stage two A and two B are one centimeter each side of the hymenal plane, the opening.
So you get some women who have a stage three prolapse and they're not super bothered by it. Like, and you look at, you assess them and you're like, okay, there's the part of the vaginal wall, you know, there's prolapse coming down quite significantly when we assess, but the woman's like, it doesn't bother me that much. I just push it back up. Then, you know, don't feel it that often. And then there's women who have prolapse that technically would be considered stage one.
or maybe stage two, a small stage two A, and they're really, really bothered by it. They feel it a lot. They, yeah, it takes over everyday life. And that's where that biopsychosocial model comes in as well. So many different factors as to whether somebody might feel their prolapse more and be more bothered by it. And we really need to look at all of those factors and, you know, not just treat objectively what we're seeing.
great subject in telling us.
Jen (18:05.966)
Yeah, yeah. Do you think that women that exercise more would be more bothered by a grade one prolapse than something more?
Taryn - FitRight Women's Health (18:17.241)
That's a good question. I actually think the research shows generally that women who exercise more are probably less bothered by it. Just when we think about things like global strength, there is some, I guess one part of them, there's so many different ways that that question could be answered, I think, but there's...
One thing that comes to mind is that women who are globally stronger in their everyday life probably strain less with activities. They probably would lift something up off the floor more effortlessly than a woman who exercises less and is more deconditioned and would have to strain more with that same movement. That second woman might feel that descent more as she strains more with things in her everyday life.
Jen (18:50.734)
manage pressure better. Yeah.
Jen (18:59.662)
Yeah.
Taryn - FitRight Women's Health (19:12.589)
Obviously there's a point where very high load and high impact exercise might overload the system too much and during or after that exercise session that woman might be more symptomatic because of the load of the exercise program. And obviously somebody who's doing a Pilates class where they're lying down most of the time versus somebody who's doing a CrossFit session.
there might be more chance for a prolapse to descend in a more loaded and upright exercise session. But yeah, no.
Jen (19:48.182)
Yeah, interesting. That makes sense. And it's also things like, I guess if you're an exerciser, most people have been taught, not that everyone does it, to like breathe out on effort. So if you are doing things like that in daily life, then you're picking something up off the ground, probably your natural, you know, what's the word?
inclination, that's the word, is to breathe out as you're picking something up. That is to say not everyone does because a lot of people just hold their breath when they're exercising and we need to deal with that as well. Yeah, yeah, yeah, absolutely. So on the flip side, if you've got somebody who is a I don't know if the terminology is is high exerciser or a cross fitter or someone doing
Taryn - FitRight Women's Health (20:19.641)
Yes, yes, yes, pressure management is a massive. Yeah.
Jen (20:37.262)
average to higher intensity exercise and they have more like a grade three pro lap. Is it grade or stage? I can't remember what you just said. Stage, stage. I'm mixing up tearing grades to gray. Stage three, but they're not bothered by it. Would you be more bothered by it because of the type of exercise that they're doing?
Taryn - FitRight Women's Health (20:47.289)
Yeah, yeah, stage. Yes.
Taryn - FitRight Women's Health (21:00.761)
That's interesting. I imagine by the time it's stage three and it's coming right down low like that for somebody to be doing a high load exercise session, they probably will be aware of it. And they're probably the cohort that would be wearing a pessary or considering surgery if they really want to continue that. I'm thinking more like the elderly, the post -menopausal woman who has this low prolapse and is just
getting on with gardening and living your life and everything and you're surprised by how low it is. Yeah, sorry, what was your question, Jen? It was...
Jen (21:36.654)
I think I was just trying to more figure out that, yeah, if somebody was not bothered, so let's just say an anybody was not bothered by a stage three prolapse or like stage two that you kind of worried is gonna get to stage three. Do you, because what I heard you say before and I completely believe in what you're saying, you know, it's not only the symptoms or the anatomical presence of whatever is happening, it's also the way that she feels about it. But if she's not bothered by something that we feel is,
Taryn - FitRight Women's Health (21:50.041)
Yes.
Taryn - FitRight Women's Health (22:01.817)
Yeah, I'm out of it, really. Yeah.
Jen (22:05.902)
on the more severe and I hate, I hate a lot of language around this stuff, but severe side, are we then being bothered for her?
Taryn - FitRight Women's Health (22:08.761)
Yeah.
Taryn - FitRight Women's Health (22:12.697)
Yes, are we being, that's a good question. And the way that I put it to women and often, you know, often the sort of proactive pelvic floor assessment where somebody is not necessarily symptomatic, but they're getting their pelvic floor assessed and their prolapse assessed is in the postnatal period. I think a lot of us women's health physios would be looking at not just what they're like now, but what their prolapse risk profile is like for future. And then that
Whether or not I'm bothered by that is a bit irrelevant, but it's putting that to the woman and being like, okay, so you This is this is what I've assessed your prolapse as being right now There's you know, 50 % of the population have a prolapse of the female population of a prolapse like this may or may not be a problem, but here's the thing is that you because you also have a high degree of Distensibility like when when you bear down it actually moves
quite a lot and the prolapse descends quite a bit or the vaginal opening opens quite a bit because you have a pelvic floor that's quite weak and when you do do a cough or lift there's not much extra support coming in because you do have a wider hiatus space in the vagina. These are things that you know we sort of put all together as a whole.
to explain to that woman not just what she's like now, but what her risk profile might be of that prolapse worsening over time, and then allow her to decision make. And that's where pessaries come in, I guess, is like, if she is on that higher risk that there's not a great amount of support there currently, and that if she loads the area chronically, regularly, that things might.
Jen (23:46.286)
Hmm.
Taryn - FitRight Women's Health (24:08.569)
descend further, she might decide that wearing a support pessary inside either through the whole day or just when she exercises might be a good option for her to decrease the chance that things are going to be moving down when she loads. And looking at it as a whole that I guess, and when you were asking me about my history and where I've come from and everything,
Jen (24:24.054)
Hmm. Yeah.
Taryn - FitRight Women's Health (24:36.665)
I imagine that you've probably gone on this journey too, but I think 10 years ago, 15 years ago when I started in women's health physiotherapy, I think that prolapse diagnosis was like a death sentence to loaded exercise. Like, you know, it was very much like, prolapse. Okay. Don't lift anything heavier than five kilos. Don't, you know, don't, don't do upright exercise. Don't squat with your legs wider than your hip.
Jen (24:58.318)
Mm -hmm.
Taryn - FitRight Women's Health (25:05.049)
you know all of that and a lot of those myths have been debunked okay but but yeah it's it's sort of work we know now that prolapse and vaginal health and pelvic health and everything is is just one puzzle piece of the we see it a bit more as like a puzzle piece of overall health and are we going to compromise her bone health her mental health her heart health all of that for the sake of her pelvic health.
And can we modify something pelvic health -wise and prolapse -wise so that she can still be meeting all those exercise recommendations to, you know, maximise her health in those other areas. So, yeah.
Jen (25:50.638)
Yeah, there were so many things that were going through my head when you were speaking then. And I think one of the key things, when I heard you say, are we going to compromise like all her other health markers for a pelvic health, the first thing I'll be super honest that popped into my head was like, well, if her organs are falling out, she's not doing any of those anyway. But then what I really loved is after that, I heard you say, if we can modify things to be pelvic floor friendly, then...
Taryn - FitRight Women's Health (26:16.389)
Yes.
Jen (26:19.694)
we can continue to do those things. And I think that is like one of the biggest takeaways that a mom or a trainer that works with moms can take.
Taryn - FitRight Women's Health (26:25.625)
Yes, that's right. We've got to sit somewhere between that uber conservative, don't lift anything ever again, and the not caring about pelvic health at all and not taking it into consideration and not training a woman without even knowing what her prolapse profile is. Loading her excessively because we want to just get as strong as possible, no matter the cost. There's got to be something in the middle, doesn't it? Like where...
Jen (26:44.046)
Hmm.
Taryn - FitRight Women's Health (26:55.257)
where that woman ideally is empowered to know what's going on inside so that she can then modify and she can get a trainer to help her modify to keep loading as much as she can, keep her cardio fitness going as best she can, keep exercising, doing what she loves and daily life as well, what she loves in a way that doesn't compromise her specific situation.
Jen (27:20.75)
Yeah, and it really is about finding that sweet spot, isn't it? And it's different for every single woman. It's not about wrapping her in cotton wool. It's about going, who is this person in front of me? What can she do? Because, I mean, correct me if your views are different because they obviously can be, but it's about going, where can she train her whole body up to the point at which her pelvic floor can cope?
and maybe a little bit, but let's not tip off the edge because we want her pelvic floor to get stronger, right as we go, but we don't want it to become, yeah, to reach past that point of stronger or yeah.
Taryn - FitRight Women's Health (27:57.753)
Yes, and it's really hard. Prolapse and knowing where that line is is really hard because if we were talking about stressing continents, you know where the line is, you're linked. But with prolapse, there can be like a prolapse point, you know, like a point where, like there's a leak point, you know, there can be a point where you become aware of your prolapse. But is there actually a point before that where you're not being aware of it, where things are descending? I find it.
Jen (28:02.446)
Hmm.
Jen (28:06.19)
you like, yep, yep.
Taryn - FitRight Women's Health (28:25.913)
think most of us working in this space would find it harder to kind of know where that point is. But what I love is like helping women work with a trainer or in our classes or both to or at home by yourself even to just get stronger and continue to load but then have check -ins relatively regularly to just give her peace of mind that things are that a pelvic floor is
doing what it's supposed to do, that it's optimal strength and endurance and that she's improving that and that the prolapse is not worsening over time as she's improving all her other markers externally. And I think finding a team that can do that, that can like manage, manage that things are not worsening internally while still continuing to build strength externally is a really important part of prolapse management.
Jen (29:04.654)
Yeah.
Jen (29:20.014)
Absolutely agree. Taryn, if someone was coming to you with symptoms, so let's say symptoms are like, you know, kind of dragging feeling or heaviness or I heard you say before, like not being able to like you don't potentially don't empty your bow or your bow empties, but you you know, you wipe and it's not quite clean, let's say. Let's go two ways. One, are there more symptoms that women need to be aware of or trainers that are working with women need to be aware of? And then number two, when they come in,
to a clinic to see a women's or pelvic health physio, what are they going to endure? How scary is it really? Yep.
Taryn - FitRight Women's Health (29:55.513)
You
Yeah, so the first thing about the symptoms is firstly, like I used the word bulge, but also we use the word heaviness a lot. And I think a big part of heaviness, like that symptom of heaviness, we need to be careful that the heaviness, that a part of our assessment is diagnosing whether that heaviness is actually prolapse or not. Because a big reason why you could have a heavy vagina feeling.
especially after after exercise at the end of the day, could be an overactive tense pelvic floor and like dongs, you know, delayed onset muscle soreness in the pelvic floor muscles and pelvic floor that is just constantly on to the point of detriment is going to sometimes cause very similar symptoms to what people would think a prolapse is. And so,
That's going back to what we were talking about before where sometimes symptomatic women don't actually have objectively a very large prolapse. Sometimes that can be because their symptoms are not necessarily to do with, they've got a mild prolapse which they've maybe felt themselves or something. And then maybe their response to that has been to overcompensate with the pelvic floor all the time.
Jen (31:19.47)
Hmm, tics.
Taryn - FitRight Women's Health (31:21.849)
And then that's given them these symptoms of vaginal heaviness. And then they're in this like, yeah, they're more protecting and they're more worried about it than they're in the vagina. And they're thinking about the vagina all the time. Yeah. And so, yes, while the symptom of vaginal heaviness can definitely be prolapse related, one of the things in that assessment that we would be wanting to know is...
Jen (31:26.83)
because then they're doing more pelvic floor exercises and more pelvic floor exercises. Yeah.
Jen (31:37.838)
think about.
Taryn - FitRight Women's Health (31:50.937)
Yeah, what exactly is that definitely related to prolapse or a refractive pelvic floor? And then the other things, yes, the emptying of the bladder and bowel. The bowel symptom actually, if it's erectus, like if it's a low bowel prolapse, the rectum coming down into the back wall of the vagina, the symptom can sometimes be like feeling like they need to splint with their hand on the back wall of the vagina or the perineum.
to be able to get the poo to come out. Yeah, so those are some of the symptoms. Not necessarily, like sometimes leaking with urine can be associated with prolapse, but sometimes they're not linked. Like you can have stress incontinence without having prolapse and you can have prolapse without having stress incontinence. And sometimes actually having a front wall of the vagina kind of kinked down.
is actually a bit protective sometimes of stress incontinence and when that gets repaired surgically or lifted by a pessary sometimes that can unmask.
Jen (32:55.662)
had a client that experienced that and she had a prolapse and then she fixed it and then she had like experiencing continence afterwards. Yeah.
Taryn - FitRight Women's Health (33:01.177)
Yeah, yeah. So in answer to your question about what would be done, I think you used the word in. I always ask that question when a woman is sitting in front of me, I'm like, that's part of the initial questioning. So what are you expecting from today's appointment? Do you know what a women's office is? Because most of the time people who are seeing me seem to be aware that.
Jen (33:08.014)
What are you doing to me?
Taryn - FitRight Women's Health (33:29.689)
a vaginal exam is likely to be involved in an assessment with me. I make sure that everybody realises that you can assess the pelvic floor externally with a real -time ultrasound or even looking from the outside at the vaginal opening. But that the ultrasound in particular is really limited with regards to what that woman will come away understanding. So.
You can't assess prolapse with a transabdominal real -time ultrasound. You can't assess for sure whether somebody has an overactive pelvic floor or not. And you can't give them advice about like their risk profile for pelvic floor worsening. You can't assess strength of the pelvic floor. You can just assess when they do their pelvic floor contraction, is it lifting? You can give a program from that, but I just make sure women know you don't have to do a vaginal exam.
Jen (34:17.23)
Does it lift? Yep.
Taryn - FitRight Women's Health (34:25.785)
but this is what you'll get out of a vaginal exam that you wouldn't get out of an external assessment of your pelvic floor. And if they do opt for a vaginal exam, what would be involved? I'd explain to the woman that I will look from the outside first, part the labia, look at what I can see, get that woman to bear down. I would take a measurement of what that, the area.
of her genital opening, her vaginal opening and the perineum is at rest and then how much that when she bears down how much that moves and there are markers that's a part of the prolapse risk profile assessment. So yeah that's right and then I'd look at her doing a pelvic floor contraction and I'd tell her you know if you're doing this correctly I should be able to see from the outside that that's lifting and letting go.
Jen (35:06.254)
That's the GH plus PB. Is that right? Yep. Yep. Cool.
Taryn - FitRight Women's Health (35:19.321)
Then I do the internal exam with my fingers inside on the muscles. Let's see, glove, lubricant. Assessing for pain, assessing for tone, assessing what I can feel when she pulls on her pelvic floor and whether she's letting go well. And I can sort of test what a program would be for her pelvic floor strength like that. Then I will always, when it's a prolapse assessment, assess in standing as well.
Jen (35:46.606)
Hmm.
Taryn - FitRight Women's Health (35:46.745)
So get that woman up in standing if she can sense. I always, I'm always like, I know this is awkward, but if it's okay with you, I'm going to assess your prolapse in standing as well. I know this is so awkward for you, but it gives me so much information. And they're always like awkward for me. What about for you? Yeah, I'm like, I do this multiple times a day. Don't worry about me. We're like standing on a bluey feet apart, little bend of the knees. And then I'll look from the opening. Like I'll be down.
Jen (36:04.846)
You're like down there with you.
Taryn - FitRight Women's Health (36:16.761)
looking from the opening there as well, and getting her to bear down there and then with my fingers internally in standing, feeling what happens with the vaginal walls, where the cervix is sitting and how much that moves and what her pelvic floor connection is like there. Obviously in both those positions as well, I'm looking at what happens with a cough or a squat or, you know, all that sort of stuff as well. Yeah, and that...
Jen (36:40.526)
Like with? Yeah. Yep.
Taryn - FitRight Women's Health (36:44.537)
that would then give me a really good idea of pelvic floor function and any pelvic floor injuries, prolapse, currently what a prolapse is like and what her risk profile is of that prolapse worsening over time.
Jen (36:57.934)
Hmm and I you know what I was envisaging you know when you go into a car like you get your car service and you have like one of those little skateboards they just like just a second I'm gonna get on my skateboard and I'm gonna zoom under your legs. That's a good rail Taran I want to see that one on your social media
Taryn - FitRight Women's Health (37:04.089)
This is...
Taryn - FitRight Women's Health (37:14.009)
I'd love that, that would be so much fun, but I don't think I'd be able to reach from lying on the ground.
Jen (37:22.478)
Like, yeah, maybe it needs to be like on a 45 degree angle. Like, I don't know. There's something in that somewhere. That was the picture I had in my head.
Taryn - FitRight Women's Health (37:26.837)
Maybe she needs to be in a deeper squat so that like when I'm... my gosh.
Jen (37:37.678)
Now I've forgotten all my questions because my brain had that visual in my head, but that's okay. Let's say that...
Taryn - FitRight Women's Health (37:42.713)
But then on that point, there are the number of people that I've met who've said that they've had a prolapse assess before and that hasn't been done in standing blows my mind. As somebody who regularly assesses in lying down and in standing, I can honestly say that in standing, it's often very, very different and I stage it differently in standing than what I do in lying down. It's just gravity is so important to take into consideration with prolapse. It's like, yeah.
Jen (37:52.846)
Mmm, yeah.
Jen (38:12.558)
Yeah, no, that makes a lot of sense. And I think I heard you say before that you would get someone to potentially do a squat or do some of the movements that they might do in the gym.
Taryn - FitRight Women's Health (38:23.769)
Yeah, yes, prolapse assessment and pelvic floor assessment with functional movements and exercises is challenging. Yeah, the ones that I think I probably do the most with a vaginal exam would be when they're lying down, I do crunches or sit ups and sometimes double leg raise and maybe like bug legs or even just double tabletop to see what the load is like there and whether they're the way they're managing pressure with
Jen (38:29.294)
Very cool. It's cool though.
Jen (38:41.422)
Mm -hmm.
Taryn - FitRight Women's Health (38:53.529)
head lift and with leg lift is pushing down all the gyno walls on them. And then in standing, yeah, I do often have kettlebells nearby to pick up or dumbbells to pick up and hold. There's certain movements that are easier, deadlift and squat like in a goblet squat sort of position. They're a bit easier to assess than some other moves with me underneath with my fingers inside.
Jen (38:56.91)
Yeah.
Jen (39:22.669)
Yay!
Taryn - FitRight Women's Health (39:23.417)
And I'm so aware of the limitations of all that, you know, like how if I'm getting them to do 10 reps of a squat with a load and I'm assessing that in clinic, I'm so aware that that might be different to if that was at the end of a 45 minute exercise class and they were doing that. And, you know, I am very aware, but I think it still is a good, good information. And if we're teaching the NAP,
you know, the ability to not just exhale on exertion, but to connect with the pelvic floor on exertion as well as you exhale. I think it's a really good way of like, not just guessing whether they're doing that correctly as we're cuing them, but to like be able to say, yes, that's it. You've got it. You've got that pelvic floor coming on as you come up. That's great. And then let go at the top and then drop down again, exhale, zip up, come up again.
Jen (40:20.046)
Yeah.
Taryn - FitRight Women's Health (40:20.217)
drop and relax. Yeah.
Jen (40:23.022)
Well, it gives it gives a woman a really good amount of feedback. Because if she can't do that in 10 reps in the clinic, well, then she's not going to be able to do it under load in in a gym after she's jumped off the air bike and the next exercise is a squat or something along those lines. And then for the women, I guess that can, it's like what what does it feel like at fatigue and and helping her to understand what her stop point is like when she needs to move from a sumo squat to a narrow led squat or drop the weight or
Taryn - FitRight Women's Health (40:37.017)
Yeah.
Taryn - FitRight Women's Health (40:52.473)
Thanks.
Jen (40:52.718)
you know, you know, you'll have other women probably that need to choose whether they do any sessions that combine cardiovascular exercise with strength training, because if she's managing her breath, and she's out of breath, then potentially she's not going to be able to manage the pressures as well when she comes to do a strength session. So I think anything that you can do in the clinic gives us more of a understanding of what's what's happening in the gym. Yeah. Yeah.
Taryn - FitRight Women's Health (41:12.217)
Exactly. Yeah. Yeah.
Taryn - FitRight Women's Health (41:18.905)
Yeah, that's really...
Jen (41:20.878)
I love it. So let's say a woman does have a prolapse. You can make up what what what stage of prolapse it is, but what are some of the things that you're going to offer her in order to relieve symptoms? Let's let's not talk pastry to begin with, but like from a, you know, what can she be doing? What should she be avoiding? Yeah. And I know it's person by person, but yeah.
Taryn - FitRight Women's Health (41:46.457)
Yeah, yeah, so yeah, it's person by person and pelvic floor training is like the bread and butter of what we do, but it's really important with prolapse management to note that your pelvic floor contraction is not, and having a better pelvic floor maximal contraction is not necessarily equal to the prolapse descending less because your pelvic floor,
Jen (41:49.934)
Hehehehe
Jen (42:03.054)
Hmm.
Taryn - FitRight Women's Health (42:14.425)
throughout 99 % of the day isn't maximally contracted, shouldn't be. So it's about doing pelvic floor training to improve the stiffness of the area, to bulk everything up and improve the stiffness of the area, and then to have that max contraction as strong as possible so that when she needs it, cough, coming up from a loaded squat, those sort of things, she's got the capacity to use the NAC and protect that area from.
from being pushed down with her muscles. So pelvic floor training is a big part of it. And that includes bulking up the muscles as best as possible, getting good strength, getting good endurance, all of that using the neck. Then other big parts of it would be optimal bladder and bowel habits, managing any symptoms associated with the prolapse, but also managing things like...
you know, if we are looking at overactive pelvic floor, like why is her pelvic floor so overactive? Is it because she's also suffering with urinary urgency and she's gripping all the time with her pelvic floor to try and stop herself from leaking on the way to the toilet? You know, like all these puzzle pieces that come in, managing all of those and putting those on a list, on a management list to look at. It's looking at the way she does daily tasks. And like you were talking about before, how she manages that.
Jen (43:25.902)
Mm.
Taryn - FitRight Women's Health (43:39.417)
pressure in daily tasks and breath work and straining and all of that. It's about looking at things that might cause chronic load over time, like managing any respiratory stuff if she's really prone to lots of coughing, managing constipation and straining on the toilet, looking at what she does in her daily life. And we don't want to take load away completely like I was saying before, like we don't want to give her
things like don't lift anything heavier than X amount. But if she is somebody who is loading a lot in her day and she's symptomatic, what can we do to adjust the way she's loading the day? Can she do more of the high load stuff early in the morning when her tissues have just had a rest? Can she have some gravity assisted time at some point in the day where she's lying down or even doing some movements or rest position where things are elevated? Yeah, can she sort of manage gravity over the day?
Jen (44:37.55)
Mmm.
Taryn - FitRight Women's Health (44:38.425)
and then a part, another puzzle piece is support. and that is some, there's a little bit of evidence in thinking about some external support where like the, SRC restore shortcomings, but I'm, I'm talking more about like internal support, like a pessary. yeah.
Jen (44:53.518)
I said, yep.
Jen (44:59.086)
So tell us what a pester is then, because we've used the word a lot. I know what one is. Some people will know and other people are like, what is this word that we're using a lot? Yeah.
Taryn - FitRight Women's Health (45:02.137)
Win!
Yeah. So a pessary is, and I think some people think of pessary as like the medication pessary, you know, like a medicine pessary. And the confusing thing is that a lot of these women might be prescribed topical estrogen, right? And a lot of the time topical estrogen comes in pessary form. The confusing thing about like
Jen (45:14.446)
You stick that up your bum though, don't you? Of course.
Jen (45:24.878)
Mmm. Yes, of course.
in a pessary, yeah.
Taryn - FitRight Women's Health (45:33.465)
putting in an estrogen pessary, but also having a support pessary. So why they got the same thing? Yeah, I think it might be something big inserted into an orifice. But the support pessaries come in different shapes and sizes and we need to find the right fit for each woman.
Jen (45:39.118)
Yeah, anything that gets inserted into something, is that what a pessary is? What's the definition of a pessary? I'll go look that one up.
god.
Taryn - FitRight Women's Health (46:03.449)
But the most common type of pessary is a ring pessary. So it's like a silicon ring that can be compressed by squeezing it so that it sort of looks more like an oval shape. And then that the leading edge of that gets put inside the vagina and pushed up. And then because it's made of that like firm but flexible silicon, it pops out that shape when it's inside the vagina.
Jen (46:11.694)
Mm -hmm.
Taryn - FitRight Women's Health (46:31.385)
and it should sit on top of the two sides of the pelvic floor muscles, the levator muscles, and on top of the pubic bone. And by sitting there, it stops the, in particular, the anterior wall, the front wall, and the bladder, and the uterus from descending as much. It's like an extra layer of support there. The reasons why that might not...
Jen (46:42.094)
Hmm.
Jen (46:54.734)
splint. Yeah.
Taryn - FitRight Women's Health (47:00.057)
work in somebody obviously as we're talking about it's sitting on top of the levator muscles if those levator muscles don't have enough bulk in it if the levator hiatus is really wide or in particular if there's an injury to both sides but also if it was just one side and it's uneven support the pessary might tip and just descend down and come out rather than sitting in place so there are other types of pessaries including a cube pessary which is like that actually goes in and
Jen (47:21.966)
Mm.
Taryn - FitRight Women's Health (47:29.785)
suctions to the upper vaginal walls and that also has the effect of holding everything up inside the vagina rather than allowing things to come down. So yes, that's that's pessary management in a nutshell and some physiotherapists, not all women's health physiotherapists have done the training to fit pessaries. There's a sort of a niche in women's health physiotherapy and some gynecologists.
Jen (47:42.958)
Mm.
Taryn - FitRight Women's Health (47:59.641)
will do it too, not all though. But yeah, definitely it used to be the realm of just gynaecologists. I think there might be some continence nurses who do it too. I don't know any in our area, but there probably are continence nurses we're trained to.
Jen (48:05.262)
Hmm.
Jen (48:10.67)
Okay. Yeah. And would a pessary, so I guess I've heard of pessaries being used earlier postpartum to prevent prolapse and potentially better retraining of pelvic floor muscles. Is that right?
Taryn - FitRight Women's Health (48:26.969)
Yes, yes and that's a newer, yeah that's the more recent application of pessaries because I think in the past and where some people's minds might still be is that pessaries are for the 80 year old woman with a stage three prolapse that is coming down and she's not a candidate for surgery, right? But like you said,
Jen (48:32.238)
Mm -hmm.
Jen (48:50.414)
Yeah.
Taryn - FitRight Women's Health (48:56.085)
application actually now is more in the perinatal population or the perimenopause population, you know, women in their 40s, 50s who are using them now. And like you said, a subsection of that is the women who are postnatal and we insert a pestery for them to wear in that relatively early postnatal period, maybe between
two or three months postnatal, say, they might get it fitted and we're encouraging them to wear it over that time during that first year, for example, postnatal. Because as you said, they might, the thinking is that they might have, that's when their connective tissue remodeling occurs, when all the hormonal changes are happening postnatal. And there's a bit of early research being done that may be wearing a PS3 in that phase when remodeling is happening.
Jen (49:34.83)
Yeah.
Taryn - FitRight Women's Health (49:52.793)
might mean that they are more likely to have the connective tissue remodel in a more anatomically correct position rather than spending that time with a prolapse down near the vaginal opening and then connective tissue remodelling happening in that position. And like you said, what about pelvic floor muscle training? If your front wall of your vagina is sitting down at the opening of the vagina, if it's can't...
Jen (50:06.446)
Mm.
Jen (50:11.598)
Ta -da!
Taryn - FitRight Women's Health (50:22.137)
prolapse down like that and then you're trying to do pelvic floor training in standing, you're probably not getting, well, you're not if it's coming down to there, the levators cannot go through their full range. Whereas you lift everything up with a pessary and then do pelvic floor training, the levators should be able to go through a better range of movement and therefore be more effective. So I offer it to women who I find who have a,
Jen (50:33.39)
Mm.
Jen (50:43.982)
Yeah.
Taryn - FitRight Women's Health (50:50.329)
symptomatic prolapse in early postpartum, but also those who I assess and find that even though they're not symptomatic, they're relatively high risk for a prolapse occurring. In particular, if they are keen to go back to higher load and impact exercise early, that's a big cohort of the women that I've been explaining to them the pros and cons of pessary management and seeing if it works for them.
Jen (51:04.302)
Mm.
Jen (51:14.99)
Yeah, so it's not it's not one of those everyone rushes out now you've had a baby have a you go get a pessary just in case.
Taryn - FitRight Women's Health (51:22.521)
No, no, we're not at that point where it would be everybody should be and obviously with a foreign body inside your body, there are always risks and the main one being some of the main ones being an erosion of the vagina wall where it's rubbing against. We minimise that risk by doing things like sending them for an assessment of whether they need topical oestrogen concurrently.
Jen (51:24.558)
No. Yep.
Jen (51:29.806)
Mmm.
Taryn - FitRight Women's Health (51:49.465)
they take it out at night and put it back in perhaps in the morning and manage it like that so that the tissues get regular rest. But yes, erosion of where it's rubbing again. and also we fit it in a way that is not super snug. You know, there's a finger width to the side so that it doesn't rub as much. And also things like bacterial vaginosis and like the, you know, the foreign body causing an infection of some sort. Yeah, we have to monitor for all of that.
Jen (52:01.934)
Mm -hmm.
Taryn - FitRight Women's Health (52:17.881)
So it's not without its risks. And it's also, I think for the women who turn it down sometimes, it's just that extra thing in their mental load when they've got a new baby, like to have to manage something like that, where it's being put in and then taken out and washed and put back in. Just having to think about that for some women, that just feels too much.
Jen (52:20.238)
Yeah.
Jen (52:40.654)
Yeah, absolutely. And when you were talking, I remember reading, I was either reading some research or listening to, could have been a podcast a couple of years ago now talking about the majority of the research had been done in that 80 year old population. And they are the ones that can't self manage as well and do end up with the, you know, erosions or the infections. And, you know, when you're saying all that stuff, it's less and less to worry, worry about for our younger women that are using it and potentially. Yeah. Is that kind of right?
Yeah, good.
Taryn - FitRight Women's Health (53:10.265)
Yeah, yeah, that's right. That's right. If you think about the risk of a woman who is in her eighties is having it inserted in a way that is not self -managed. So she has to go back every, I don't know, some people manage it, four monthly changes, six monthly changes, annual changes. I think, yeah, six monthly, I think she's probably at the limit of what that is. But.
Jen (53:22.158)
Yeah.
Jen (53:33.998)
Yeah. Yep.
Taryn - FitRight Women's Health (53:37.625)
that woman who that's in there all the time and traditionally they were they weren't as flexible and they were fit really tight that risk of erosion and and you know things like and also the forgotten pestery you know the woman who doesn't attend follow -up or develops dementia and the health care team around her does isn't aware of it for whatever reason like those are the those are the high risk ones where
Jen (53:43.022)
Mmm.
Jen (53:58.51)
No one knows it's there, yeah.
Jen (54:05.966)
Yeah, of course.
Taryn - FitRight Women's Health (54:06.841)
where maybe pessary complications get a bad name. Obviously, we have to be super cautious though, as pessary fitting physios have a really good database where we really follow women up. We know who's got one. We know that they need to change it regularly. They take it out and insert it themselves regularly, but also change the actual pessary regularly for the new one. Yeah, so.
Jen (54:31.63)
Hmm.
Taryn - FitRight Women's Health (54:35.641)
Yes, it's not without its complications, but it can be a really, really important puzzle piece for some women.
Jen (54:42.446)
Absolutely, and it can really help women, you know, get back, I hate the word get back, move forward into the exercise that they want to be doing. If they do have a prolapse or are symptomatic, it can be a real, from my experience, it's a game changer.
Taryn - FitRight Women's Health (54:55.321)
Yeah, and we haven't talked about the type of pessaries that have extra urethral support, but there are some that are specifically for stress incontinence as well. So a woman who wants to get back to running but leaks when she runs at a certain point or whatever, yeah, definitely can be a game changer for women like that.
Jen (55:05.326)
Yeah, okay.
Jen (55:13.838)
Is that the ring one with the little knob on it? Yep. Yep. Yeah, cool. Yeah. If I was a trainer and I am working with a mom who's been to see you and she now knows she has a prolapse, what are the things that I as a trainer need to be aware of? And what are some of the adaptions that I could be making within my sessions to support her?
Taryn - FitRight Women's Health (55:41.529)
Yeah, yeah, that's a really good question and I think it does depend on every different woman but I think some of the things to have front of mind would be is she someone who should be cued the knack with certain movements?
Jen (55:54.254)
Tell me, can you explain, I wrote knack down, because you've used it a few times. It's like I know what it is, but what is it? What is it? Yeah.
Taryn - FitRight Women's Health (55:56.905)
Sorry, the neck is what I was explaining before about the timing of the pelvic floor, like lifting your pelvic floor before a pressure goes down. So the neck with a cough would be lifting your pelvic floor just before you cough and then it relaxes after. Or with a chest, with a sit up, it would be lifting your pelvic floor as you come up and then relaxing afterwards. Or at the bottom of a squat using the neck.
as you come up and then relaxing. So it's getting the timing of the pelvic floor correct just at the beginning of that increase in interabdominal pressure.
Jen (56:36.398)
And that becomes audit. That's what is normally an automatic movement, right? Yep.
Taryn - FitRight Women's Health (56:39.609)
Yes, that should be automated. It should kind of happen naturally and that's a lot of what we train is like getting that link with the exhale because some women can only lift their pelvic floor on the inhale and then you get them to try and do the knack with a squat when you're queuing them to breathe out and it's really tricky. Yeah, that's what the knack is.
Jen (56:45.07)
Yep.
Jen (56:54.318)
Yes.
Jen (57:01.389)
Okay, cool, that was good.
Taryn - FitRight Women's Health (57:03.481)
But some women you want to cue the knack and some women maybe have some overactivity in their pelvic floor and it might be better just to focus on the exhale and just move. You'd want to know, you'd want to be knowing what type of movements make her symptomatic and what the regressions would be of that and then how to know when to start pushing her back to trying the progressions again.
Jen (57:10.318)
Let them go.
Yeah, yeah, yeah.
Taryn - FitRight Women's Health (57:32.057)
You'd want to maybe consider if she's really symptomatic, like structuring in some anti -gravity stuff through her programming so that she had a chance for gravity to help everything come back before she does some more upright stuff if she needs that. And ideally, you'd want to be working with a physio, like I said before, who maybe could, as you are, increasing her load or increasing her into impact or both.
that you might be re -checking in with what's happening from a vaginal point of view and then getting that feedback that, yeah, nothing's worsened. Everything's looking well supported, all clear to continue to increase the load.
Jen (58:17.39)
Yeah, fantastic. And so you're having generally two way conversations with the trainers that you're working with working with the mums. Yeah.
Taryn - FitRight Women's Health (58:24.121)
Yes, yep. And if there's anything in my session that I've found is particularly good, a good movement or anything to get that woman to like connect correctly with her core, I'll feed that back to the trainer to see if that could be like, for example, there was a lady the other day who we tried some upright like banded pulls with straight arm pull and that was such a good way of her getting her getting the correct connection with the lift and the
Jen (58:35.214)
Mm -hmm.
Taryn - FitRight Women's Health (58:52.537)
in drawer and everything. And so she just did that as part of her warm up in her programming. And she said it felt like it helped her to then remember how to connect to where that was so that when she was doing other things later, she had that reminder of, she was someone who was like often overusing, overcooking the cues and overusing her upper abs and pushing down.
And by doing that, it just reminded her, okay, that's where I got a lift from. That's the gentle pulling, not the push down and yeah, things like that.
Jen (59:24.398)
Yes. Yeah, okay. And do we cure prolapses? Do they go away?
Taryn - FitRight Women's Health (59:32.537)
No, they don't go away. It's a connective tissue deficit. So it's kind of like a hernia or a hemorrhoid. Like there's always going to be that deficit there. We just manage it in the best way possible with pressure management, the muscles around. And I think that's something that maybe I haven't said outright today, but just to make 100 % sure that we're all on the same page, that it's not just a muscle issue. It's a connective tissue issue.
Jen (59:42.254)
Mm -hmm.
Taryn - FitRight Women's Health (01:00:02.521)
prolapse is a connective tissue deficit and then the muscles are just part of that support network that helps. So we just manage over time, we get the pelvic floor as good as possible, we get the pressure management as good as possible and ideally we get it to a point where that woman is not bothered by it. Research does show that you can decrease the stage of a prolapse but that's not always the outcome. Sometimes we're just
the stage of the prolapse when they bear down comes down to the same level, but it just doesn't come down like that in everyday life anymore because of the things they're doing. They've got globally stronger, they've got a better pelvic floor on pressure like when with the knack and they breathe differently. And then then they're not bothered by the prolapse for the rest of their life.
Jen (01:00:48.462)
Hmm.
Jen (01:00:52.302)
Yeah, I think it's really important when you said it's important to know that the prolapse is a connective tissue issue, not a pelvic floor issue. And I think I remember like when you visualize, you know, the organs of the pelvis and the organs being strung up from the pelvis by ligaments and you kind of forget sometimes that there's a whole lot of connective tissue in there kind of going around them and then the pelvic floor muscles kind of come up under that. Yeah, because you can have a prolapse without having a weaker pelvic floor, right? Yeah. Yeah.
Taryn - FitRight Women's Health (01:01:10.149)
yeah
Taryn - FitRight Women's Health (01:01:19.645)
Yeah, that's funny. But if you have a weak pelvic floor or a pelvic floor injury, you're just more likely over time for gravity and other effects to take place on the connective tissue. So the pelvis will definitely fits into that picture for prevention of prolapse happening or worsening over time. It's just that it's not the main issue. It's not the main cause.
Jen (01:01:30.286)
you're more at risk.
Jen (01:01:36.334)
Yeah.
Jen (01:01:43.534)
Yep.
Jen (01:01:47.15)
Yes. Yeah. Taryn, I don't think we're going to get to to the the preventative side of things because we'd be here for another hour. I think I'm having such I can't believe actually how quickly the time's gone because I'm having an absolute ball. So we will book in a part two if you're open to that you get to say no Jen I'm done. That's fine. I don't want to come back. But if you'd like to, to start to wrap us up.
Taryn - FitRight Women's Health (01:01:53.753)
Thank you.
Taryn - FitRight Women's Health (01:01:58.553)
Thank you.
Thank you.
Taryn - FitRight Women's Health (01:02:09.977)
up.
Jen (01:02:18.734)
What do you think, I guess, I want to just talk to fear amongst, and we talked about it a little bit at the beginning, but if a woman learns that she has a prolapse or a trainer learns that her client or their client has a prolapse, you know, there is a fear thing and depending on the women's or pelvic health physiotherapists that they've seen, they might not have got the whole picture and it's not the end of the world and it's not those things.
Like what would you say to someone who has learned that they have a prolapse or whose client has learned that they have a prolapse in order to reassure them that there is a moving forward?
Taryn - FitRight Women's Health (01:02:56.377)
Yeah, definitely. I think that one of the big things that often helps is just women realizing that, you know, especially if they've had multiple vaginal births, that not having any degree of prolapse is probably less common than having some degree of prolapse. Yeah, I know. So like, especially if it's a fairly asymptomatic prolapse that they've been diagnosed with, that, you know, somebody has said when you bear down your vaginal warm moves like this under load and they have freaked out at that.
Jen (01:03:09.358)
Huh, that's cool to know. It's not cool, but.
Taryn - FitRight Women's Health (01:03:24.729)
just realising that it would be way less common for their vaginal wall not to move at all. And that doesn't, that isn't a life sentence for no exercise. That isn't a life sentence that they're going to, you know, that they're going to be restricted in lots of things because of it. It's just something to, it's good to be aware of and it's good to know your own risk profile so that you can decision make, but it's not a life sentence that you can't do anything.
Jen (01:03:29.454)
Mmm.
Taryn - FitRight Women's Health (01:03:53.529)
And especially if they're not very symptomatic, the best thing to do is just to keep going. Pelvic floor training generally gets strong. You can't go wrong with getting strong as long as you're not ignoring your pelvic health concurrently. So just, I think that's the big thing is like just not seeing it as a life sentence for low load. And realizing that yes, there will be some women who do need surgery for this.
Yes, there will be some women who maybe need to rely on a pessary. There are a huge amount of women with mild prolapse who just get strong pelvic floor, strong globally, learn how to pressure manage, learn how to open their bladder and bowels in a way that normalizes everything, and they get on with life without having to up their head in the vagina all the time. And that is a big part of symptom. There's lots of research done on symptom.
on the sort of yellow flags of all of this and of symptoms being worse because of women's beliefs and fears around prolapse and that those yellow flags can have such a huge impact on the way that that woman is feeling her prolapse. So I think a big part of this is somehow us trying to not diminish the fact that prolapse management is important.
Jen (01:04:57.678)
Hmm.
Taryn - FitRight Women's Health (01:05:16.089)
but also not put too much emphasis on prolapse being really bad, terrible, that she'll have to spend lots and lots of time thinking about and managing.
Jen (01:05:20.526)
Mm.
Jen (01:05:26.254)
Yeah, absolutely. And then what about the woman who's a, let's say she is a crossfitter or a powerlifter and it's not, yeah, she wants to do that kind of more intense exercise. What does her outlook look like?
Taryn - FitRight Women's Health (01:05:40.121)
that would totally depend on how symptomatic she is and how much it bothers her and everything. There are heaps of crossfitters who have prolapse. I mean, if you think about how what a high percentage of women have prolapse and what a high percentage of women do crossfit, like there's a, the Venn diagram has a big overlap. And yeah, it would just be working out how she can do that without symptoms bothering her.
Jen (01:05:42.222)
Yeah, okay.
Jen (01:05:56.686)
It does, yep.
Taryn - FitRight Women's Health (01:06:09.305)
and with being confident that she's not setting herself up for worsening it over time.
Jen (01:06:14.766)
Yeah, because that's when my brain goes after that. It's like we might get away with it now, but what happens when we are 65, 75, 80?
Taryn - FitRight Women's Health (01:06:25.081)
Yeah, yeah and that's...
Jen (01:06:25.966)
Do we even know that yet? I don't feel like we don't know that yet because we've not had the cohort of women exercising to this high level get to that age in their life yet.
Taryn - FitRight Women's Health (01:06:32.601)
I know, yes, it's true. We don't know, but I guess what we do know is that women in their 30s and 40s have a lot more load on them with railed rearing and everything as well, and are probably choosing higher load exercise and maybe their general load in their life isn't going to be as high in their 70s and maybe the things that are causing it now might not cause it. We just don't know.
Jen (01:06:45.358)
Mm.
Jen (01:06:59.47)
It's really interesting, isn't it, when you think about it, because from what you were saying before, you've got this, the women that are in their 75, 70s and 80s now have maybe not done the high intense, like the heavy exercise, not necessarily intense, because there was aerobics and all that kind of thing. And I'm sure there was some women that are older that were weightlifting, so I don't want to discount them. But it could go one or the other way. It could either go, well, we're stronger because we've been doing that, therefore,
our outcomes are better, or it could go well, we've been doing that for much longer period of time, therefore our pelvic floor outcomes are worse.
Taryn - FitRight Women's Health (01:07:40.441)
I think you're right, it could go. And there are definitely recent studies that have looked at this in particular in CrossFit populations. And generally, and it's, you know, different studies show different things, obviously, but generally, it's the first. It's that there's not a huge increase in prolapse in women who are CrossFitters.
Jen (01:07:41.39)
Hehehehehe
Jen (01:07:47.726)
Yeah.
Jen (01:07:56.75)
Good.
Jen (01:08:04.814)
Yeah, interesting, interesting, interesting. I feel like that's a that's the perfect spot to go to be continued.
Taryn - FitRight Women's Health (01:08:11.065)
Jen (01:08:14.446)
Taryn, I've had an absolute ball having a chat with you and I've still got lots of visuals going through my brain. Thank you.
Thank you so much for joining me. And it's been really great to chat. Like we were chatting before we got on the recording and it was probably what six years ago that we met at the Women's Health and Fitness Summit. And we've not really like we've, you know, moved around each other and exchanged the odd message or the Instagram comment here and there, but it's really cool to spend a good hour chatting with you. And thank you for making the time for me and for everyone that's listening to jump onto the podcast and share all of your wisdom.
and amazing.
Taryn - FitRight Women's Health (01:08:54.681)
you're very welcome, Jen. I think when I first came across you and met you all those years ago, I remember thinking, I found a like -minded soul. And now, like you said, there are more of us in this space. But at the time, it felt like a lonely space to be. And I've always felt like you were somebody who was singing from the same hymn book as me. And I've really appreciated watching what you've done in business as well.
Jen (01:09:17.87)
Absolutely.
Thank you. It's definitely an evolution, isn't it? And yeah, there's also that podcast on how business and motherhood is hard, but that's for another time. Taryn, I'll let you get on with your afternoon, but thank you so much for being with us. And we will chat again soon, hopefully. Take care.
Taryn - FitRight Women's Health (01:09:28.377)
Yes. Definitely.
Taryn - FitRight Women's Health (01:09:38.489)
Yes, thank you Jen.
