There is no denying our bodies are different postpartum, especially down there! For some reason, though, society expects us to pop out a baby and bounce back like nothing happened. On the other hand, doctors and physical therapists tell us we can't lift over 25 pounds or should never do crunches again. Both of these are unrealistic AF, so what the hell are we supposed to do?!
Dr. Carrie Pagliano is a pelvic floor physical therapist specializing in women's health for nearly 25 years. She's a double board-certified clinical specialist in orthopedics and women's health and served as president of the Academy of Pelvic Health Physical Therapy.
In this episode, Dr. Carrie and I chat about the sexy topic of pelvic floor health, how your body changes during and after pregnancy, and how to realistically approach fitness postpartum.
Topics Covered:
- What a pelvic floor is and what a pelvic floor physical therapist does
- How pregnancy impacts the pelvic floor
- What diastasis recti is and what to do about it
- Can vs. should and the importance of building a base when going back to working out and running
- The importance of finding a physical therapist or doctor that understands you / how to know if the person you're speaking to is the right person for you / The red flags to look for
- What to consider when using compression support postpartum
- Weeding out the BS and vetting resources
What are you most concerned about postpartum? I would love to know! Message me on Instagram to let me know and tell me what topics you want to hear more about or who I should have on the show.
Connect with Dr. Carrie Pagliano
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The podcast transcript for this episode of the Unfiltered Fit Life podcast follows
[Nathalia Melo]
Hello, hello there. Welcome to another episode of the Unfiltered Fit Life Podcast.
And today we have an incredibly amazing and competent guest that I've had the pleasure of meeting personally. And I do, she should charge me some bragging rights because sometimes I'm like, do you know who I know? So today we have Dr. Keri Pagliano, and Keri is a pelvic floor physical therapist, and she specializes in the areas of women's health. And she has been doing so for the past almost 25 years. And you know, she received her Master's of Physical Therapy from the University of Science in Philadelphia and the Doctor of Physical Therapist from the University of St. Augustine for Health Science.
We're not going to say years because we want to stay young.
And we want to stay young. And she's also a double certified clinical specialist in orthopedics and women's health. And for seven years, Keri served on the executive board of the Academy of Pelvic Health Physical Therapy.
And you were the president of that as well, weren't you?
[Dr. Carrie Pagliano]
I was, yeah. I finished all my service right as COVID started. So good news, right?
[Nathalia Melo]
Smart lady. Well, welcome. Did I miss anything? Was there anything that I butchered? Supermom?
Dr. Pagliano’s Personal Life and Introduction
[Dr. Carrie Pagliano]
I tried to convince you have so much. Yeah. No, I mean, I think probably the most important part is the two kids that I have managed to keep alive for a while like that.
And they taught me more about anything than many of the education courses I've taken.
[Nathalia Melo]
So doobie facts, doobie facts. So let's go back. So I met Keri in a seminar that I was doing with Anthony Lowe, who is another very respected and known physical therapist from Australia.
And I was there surrounded by all these smart people. And I'm like, holy shit, should I even be here?
[Dr. Carrie Pagliano]
That was so fun because it was so cool to just watch you be like, wait a second, there's something here, I got to figure this out. It was watching like the internal struggle. It was really cool.
[Nathalia Melo]
Yeah, yeah. And, you know, this was back and at that point, I had already taken a whole bunch of pre-imposed NATO courses. And I had been, you know, a personal trainer for a long time.
Many years. Yeah. Let's keep the dates out of it.
[Dr. Carrie Pagliano]
Exactly.
[Nathalia Melo]
It ages us. The Botox is doing a good job. Anyway, I digress.
What Is a Pelvic Floor Physical Therapist?
[Nathalia Melo]
Talk to us a little bit about what exactly a pelvic floor physical therapist is because I feel like a lot of people don't know what that is.
[Dr. Carrie Pagliano]
And to be honest, it's changed so much. How I work now is not at all how I worked when I started. I mean, essentially, ideally, we have a better understanding, we have additional education in how a pelvic floor works.
And it used to be primarily just working with women. There's a lot of pelvic floor physios now that work with men that work with kids that work with all sorts of different aspects beyond pregnancy and postpartum work with geriatrics, people that have neurological issues, things like that. But me specifically, I've mostly done women's pelvic health my entire career and really have kind of hyper-niched since I had my own kids, and they're nine and 12 now, working a lot with pregnant and postpartum athletes because I feel like moms are so much more active than they ever were before.
And just really want to get back to doing that stuff. And there really hasn't been a ton of resources. So for me, now doing this for 25 years, I encompass, yes, the pelvic floor, but because I work with athletes, I need to know how the rest of their body works, I need to know about how they manage pressure, if they're lifting weights, like how they manage impact, if they're running, like all sorts of things like that.
So for me, it's the best job in the world because I get to do a little bit of everything. But yes, it does come back to the pelvic floor and symptoms like leakage or prolapse or things along those lines.
The Basics of the Pelvic Floor
[Nathalia Melo]
Okay, before we even start talking about because I feel like there are many women that don't even know what pelvic floor actually is. And I'm not saying this as a way to shade anybody, but I really want to make this podcast as educational as possible.
Yeah, because I really do think that even knowing what it is can help answer a lot of questions or at least know where to go for answers.
[Dr. Carrie Pagliano]
Exactly.
[Nathalia Melo]
So what is the pelvic floor?
[Dr. Carrie Pagliano]
So it's a muscle just like any other muscle in your body. I think people kind of think of muscles as like biceps or quads or glutes or things like that. This is just like that.
But it's kind of strung like a hammock between your tailbone and your pubic bone in the front. So it kind of acts as a hammock. And it works in a lot of different ways.
It helps a lot with posture. It's peeing, pooping, sex. So really important things there, it makes sure that it keeps the pee and the poop in and lets it out and relaxes when you're trying to go to the bathroom.
It's that muscle that contracts really strongly in orgasm. So really important muscle there. It's the muscle that has to relax and get out of the way in vaginal delivery.
It's a helper breathing muscle. People don't realize that. But I think the thing that people really, you don't really almost have permission to talk about it until you have kids...
Pregnancy and Postpartum Impact on the Pelvic Floor
[Nathalia Melo]
How does pregnancy and postpartum impact your pelvic floor?
[Dr. Carrie Pagliano]
Because we are vertical bipedal, so we're on two legs standing upright. That makes it so when we are pregnant, there's a lot of pressure downward on the pelvic floor. A bajillion and one years ago, when we were on all fours, that pressure went through our belly.
The pelvic floor really wasn't taking a lot of the brunt on that. So that's the other thing to remember, too, is that the purpose is kind of like the job has shifted because we got vertical. And so you not only have the organs that are in there, you have your bladder that's constantly filling and emptying, you have your rectum that's filling and emptying, you've got this uterus that's growing and extending kind of up and out so that it's going out of your kind of your belly.
And that's where the fetus is growing. That's a lot of pressure downward. So that's the other thing, too.
People don't think that you would have pelvic floor issues if you had a cesarean section. And you can. I mean, I did.
I had two C-sections. I still carried babies for nine months. So that can still play a role.
So the actual delivery is just part of the equation. It's not the whole thing. No, because, I mean, you're still pregnant for nine months.
And so but again, people tend to think, oh, vaginal delivery, that's the first time the pelvic floor is involved. And it's not. It was it's literally been involved since the day you were born.
And so that's something that people don't realize is how a lot of the issues that don't come up until pregnancy or postpartum, we can actually go back and look like, you know, did you have leakage when you were a kid? Did you have bedwetting when you jumped on a trampoline or did you giggle? Did you have leakage then?
What sports did you do that kind of stuff that can kind of give us a sense of how you use those muscles? Were there any issues with those muscles before you even thought about getting pregnant?
Buzzword Breakdown: Diastasis Recti
[Nathalia Melo]
Okay. I love that. Now, we're going to move on to the buzzword of the moment.
And I think, you know, there's so many, you do. You got to narrow it down. There's too many, too many variables.
Okay.
[Dr. Carrie Pagliano]
Diastasis recti. That's where I figured you were going, but I didn't want to throw out a buzzword that we didn't need to freak people out with.
[Nathalia Melo]
Yeah. So diastasis recti. And before we start talking about diastasis recti, I actually want to tell you, when I was a guest in your podcast, I'm not sure if I told you this story, but I had, I have a member in our community who just had a baby.
She's in Switzerland and she came to me like panicking because, you know, her doctor said at the six weeks that she was cleared to exercise, but the only thing she couldn't do was crunches because she had a gap, big gap. And then she went to a pelvic floor physical therapist and then the pelvic floor physical therapist told her that she needed, she's like, you are just so much a scaremonger about everything.
[Dr. Carrie Pagliano]
I know.
[Nathalia Melo]
So let's talk a little bit about diastasis recti and what it is.
[Dr. Carrie Pagliano]
So when we are pregnant and guys can get this too, like guys with like big old bellies, this can happen too. But in pregnancy, the baby has to go somewhere. So the abdominals, I think of like the hottest guy that you know, with amazing six pack abs.
Okay. They still have that line down through the center and hot girl, six pack abs, same deal. So this is like not pregnant.
You feel, you see that line down the center and that's the linea alba and that's just a line of tissue. So when you are pregnant, that line of tissue, its job is to start to stretch. And what ends up happening is like two sides of the six pack, they start to separate just a little bit, but they're still connected.
It's not like there's been slicing or dicing or things like that. Like they're still connected, but that linea alba or that tissue has to stretch and kind of get out of the way. And so that tissue changes in a hundred percent of pregnant women.
Now I think where it gets scary is then you start to put a term on things and then people get freaked out. So in postpartum, obviously baby's not in utero anymore. Obviously the body ideally is going to go back or try and return to the location where everything started.
The way I explain it is basically your abs change zip codes. And so it's like one zip code and then it kind of changes to another one and it's trying to move back. And some people, it works like genetically, some people do really, really well and everything goes back.
Can vs. Should: Making Informed Decisions
[Nathalia Melo]
And another thing that I think it's interesting to add is that go back to normal. Yeah. What does normal look like?
And I think that that's what a lot of people don't really know. Did you ever measure what your gap was before pregnancy? Chances are you probably did not.
[Dr. Carrie Pagliano]
Well, and I think the other thing, I mean, I had a really interesting conversation with a client today just talking about what their expectations were for their body. And there's some people that really and again, it's not a good or a bad thing. It probably makes it quite challenging postpartum that honestly, truly believe that their body should be exactly the same postpartum as it would be before you had a kid.
But we're older, obviously, ideally, if you had a kid, you're nine months older, like there's normal changes that occur...
Diastasis Recti: Causes and Misconceptions
[Dr. Carrie Pagliano]
...And those are those people that kind of walk out of the hospital in their pre-pregnancy jeans.
[Nathalia Melo]
That wasn’t me.
[Dr. Carrie Pagliano]
That was not me either. Nope. Nope. I had to send my mother-in-law to go get bigger underwear because my legs were so swollen.
[Nathalia Melo]
Same.
[Dr. Carrie Pagliano]
Well, yeah. C-section, you got it. So what happens is ideally as those tissues are healing, sometimes those two sides don’t come back, so to speak. I hate saying "come back" because it’s like they just don’t come as close as they once were.
Because that linea alba tissue doesn’t have as much elasticity, I guess, or gets to kind of come back. And so that’s where you can kind of see that space. But the other thing that we’re kind of looking at too, and sometimes that can improve with time, just depends on the person, is also the depth.
And so if you were to do that test where you kind of come up and do like a half crunch and you stick your finger in that space, how wide is the space and then how deep is it? And that’s where people get totally freaked out because if the pressure pushes through from the abdomen, then it makes it look like coning or doming, which everybody’s all freaked out about. And it’s really like, so what?
Pressure Management: A Key to Healing
[Dr. Carrie Pagliano]
It’s just pressure.
[Nathalia Melo]
Just a symptom.
[Dr. Carrie Pagliano]
Exactly. It’s just that. We’re just showing you what’s happening. The only time you worry about it is if there’s like guts spewing out, aka like a hernia.
I mean, I have a tiny little umbilical hernia. It doesn’t bother me. It was from my second kid. It’s not painful. No organs are being strangulated. It’s a non-issue.
But what we can do is we can make that depth better by learning how to turn on our deeper abdominals. And so for a really, really long time, the researchers were like, the gap is bad. Don’t do things that entice the gap.
And so that’s where the whole like sit-ups, crunches, planks, all that stuff was bad. And it was that way for a long time. And then a couple sets of researchers were like, oh, well, let’s use our abs.
Changing Perspectives on Core Engagement
[Dr. Carrie Pagliano]
And what they realized then was like, oh, well, if we use our abs, it actually opens the gap slightly because it’s almost like a suspension bridge. When you put a little tension on it, it goes from being a very saggy suspension bridge to pulling apart and making it a taut suspension bridge, which is actually really good.
But the people that didn’t like the gap were like, ooh, this is bad. It makes the gap worse. Don’t do this stuff.
But the other group was like, oh, what does this actually mean? And so by learning to engage deep abdominals and getting that coordination back and kind of getting that wiring connected, you can actually generate tension better across that taut suspension bridge.
And then you’re containing pressure nicely, everything’s doing well, and it’s a non-issue. But usually most people, they talk about it because they think like mummy tummy or muffin top or things like that are related. And lots of times it’s not.
Managing Expectations About Postpartum Recovery
[Nathalia Melo]
And also another thing that I think it’s interesting to add is that go back to normal. Yeah. What does normal look like?
And I think that that’s what a lot of people don’t really know. Did you ever measure what your gap was before pregnancy? Chances are you probably did not.
[Dr. Carrie Pagliano]
Well, and I think the other thing, I mean, I had a really interesting conversation with a client today just talking about what their expectations were for their body. And there’s some people that really and again, it’s not a good or a bad thing. It probably makes it quite challenging postpartum that honestly, truly believe that their body should be exactly the same postpartum as it would be before you had a kid.
But we’re older, obviously, ideally, if you had a kid, you’re nine months older, like there’s normal changes that occur. And you just had basically like this leech growing inside of your body. And then you exit.
[Nathalia Melo]
Leech?
[Dr. Carrie Pagliano]
Well, it kind of is. It’s like that. I love my children. I do. But they took up a lot of space. There’s going to be like, you know, when somebody moves in, and then they move out, they kind of leave a mess, you know, and so it’s not exactly the same as when they moved in.
Comparing Recovery: Pregnancy, Prolapse, and Postpartum Realities
[Dr. Carrie Pagliano]
So between that, and you know, genetics and tissue changes and time and age, we’re going to be different. And this conversation I had with a client, we were talking about prolapse, where your organs can kind of move.
She had this idea of her internal organs being like a two-dimensional picture that from like health class in fourth grade. It never occurred to her that organs are supposed to move and shift. And like, that’s how it was.
So when she realized things were moving, it totally freaked her out. But I’m like, this has been going on your whole life. You just you thought the world was flat, and it’s really round.
[Nathalia Melo]
100%.
Can vs. Should: A Common Question
[Nathalia Melo]
And just kind of to piggyback on what you were talking about there on the crunches and, you know, “Oh my god, it’s the worst thing,” right? It depends, like most things in our space.
So I wanted to talk to you a little bit about the can versus should because that was something that took me a long time to like... which I think that that was what you saw whenever I was at Anthony’s seminar. You saw the can versus should kind of like having a fight in my brain.
And it’s kind of like, a lot of people ask the wrong question.
[Dr. Carrie Pagliano]
Yes.
[Nathalia Melo]
In my opinion, it’s kind of like, “Can I do toe touches when I’m like nine months pregnant?” I mean, you probably can, depending on how fit you are. But the question should be a natural one.
So can you talk to me a little bit about that?
[Dr. Carrie Pagliano]
Yeah, totally. And just to caveat this stuff too, like, I didn’t know a lot of this stuff going into having my own kids. We were taught very conservatively as physical therapists, like, “Hey, we shouldn’t do this, we shouldn’t do that. We don’t want to make things worse.”
We were taught back in the day that if you used a band to bring both sides of your abs together, it would teach them to work in that new position. Like, that’s just not how it works.
The Importance of Building a Solid Foundation
[Dr. Carrie Pagliano]
And that’s the thing that it’s one of those things that can you do really hard stuff? Yes. But it’s going back and like, “Okay, well, what’s the cost? And is it a better idea to build in a base or learn a strategy?”
So like, when I’m first working with moms, it’s really important to reconnect the wire and refine your zip code. Like it’s all about connection so that when you’re building—so for like building a skyscraper—we’re building on top of a really solid foundation instead of building on a shoddy foundation, that when you get to a certain point, something’s going to give.
Returning to Running Postpartum: Misconceptions and Risks
[Nathalia Melo]
I love that you said this because, um, that’s actually my next question that I had here because I do know that you specialize in helping women get back to running after having kids. And, you know, I think that people look at running after they have a kid a bit like the lowest hanging fruit.
[Dr. Carrie Pagliano]
Yes.
[Nathalia Melo]
“Oh, I’m just going to go for a jog. Like, you know, Oh, it’s not too much. It’s just running.” And I’m like... scrolling through social...
A lot of the things that I get is from social because if it is somebody that I know, I will say something because I have a lot of feelings.
[Dr. Carrie Pagliano]
And it’s, for me, it’s such a double-edged sword because I’ve literally run since seventh grade. I’m not fast, but I’ve done it for a really long time. It’s something that I enjoy doing.
I know for some people, it’s like their soul, their identity, who they are. And usually that’s what it is when they’re trying to get back. Or with their first kid, they feel like they have something to prove because let’s just be honest, all of us felt like we had something to prove with our first kid.
Screening Before Postpartum Running
[Nathalia Melo]
I love that you’re covering that. So if we could give like a little bit more of a, you know, so people can really understand and not have to catch from... what are, and again, this is going to be broad and if you’re not comfortable saying this, I’m perfectly okay with that. What can be the problem with getting back to running too soon after having a baby?
[Dr. Carrie Pagliano]
So big swath, big picture: your whole body is weaker. Your balance is worse. You haven’t had impact in how many months? Your brain doesn’t know how to fluctuate and work as a dimmer switch. It only knows on and off.
And so things aren’t firing and coordinating when they’re supposed to. And you don’t know how to handle pressure plus all the zip code changes and that kind of stuff too.
So you literally have an entirely different body, and you’re asking it to perform in a way that it did when it didn’t have any of those challenges.
Finding the Right Healthcare Professional
[Nathalia Melo]
So how does somebody know if the person that they are speaking to is the right person for them? What are the red flags?
[Dr. Carrie Pagliano]
I think when you have that Spidey sense—and it’s not wrong—like it’s the same thing in pregnancy too. When people are surprised about what you do or like, “Hey, I’ve always run or I’ve always lifted...”
Waist Trainers and Postpartum Garments
[Nathalia Melo]
What about the pressure? How does that come into play with waist trainers postpartum?
[Dr. Carrie Pagliano]
So again, like a little bit of support is fine to contain, but when you’re doing like that squeeze in the middle, it’s going to kind of shoot up and shoot down.
Vetting Information and Resources
[Dr. Carrie Pagliano]
And, you know, people use it as an opportunity to reinvent themselves or make up for what they didn’t have in their childhood. There’s a lot of different reasons for it.
[Nathalia Melo]
Carrie, thank you so very much for your time. Can you tell our listeners where they can learn more about you, where they can find you, if they have any questions, if they want to work with you?
[Dr. Carrie Pagliano]
Absolutely. So the easiest place to find me is Instagram. It’s @CarriePagliano. My website is CarriePagliano.com.
