In this episode, I speak with Isa Herrera, owner of PelvicPainRelief.com, about pelvic pain, leaking, and prolapse and how to fix it. Isa is a licensed physical therapist and expert in integrative pelvic floor therapies, including this free masterclass that has taught nearly 15,000 women how to have happier ‘lady parts’ in just a few weeks.
In this podcast, Isa Herrera will cover
- The most common lifestyle habits that cause pelvic pain
- Who can I go to for pelvic pain treatment? (Why most MDs and personal trainers are unable to help with pelvic pain)
- How common pelvic dysfunction really is
- How you should approach a UTI (Why antibiotics should not be your immediate go-to treatment)
- How to protect your pelvic floor
- Isa’s take on kegel exercises
Download or listen on iTunes
Listen outside iTunes
How to Fix Pelvic Floor Problems (Pelvic Pain, Leaking, and Prolapse) with Isa Herrera – Transcript
Ari Whitten: Hey everyone. Welcome back to the Energy Blueprint Podcast. I’m your host, Ari Whitten, and today I have with me Isa Herrera, who is a licensed physical therapist and an expert in integrative pelvic floor therapies. She has developed her expertise in diagnosing and treating pelvic pain, leaking, and prolapse by helping over 14,000 women since 2005 at her New York City healing center called Renew PT. Isa has pioneered the use of integrated modalities like Maya massage, cold laser therapy, which you all know I’m a big fan of (that’s red and near infrared light therapy), sound healing, and Andean energy techniques with evidence-based physical therapy in ways that had never been done before. She’s also the author of five books on the topic of pelvic floor dysfunction and pain, including the newly released international bestseller Female Pelvic Alchemy. Her new online school, pelvicpainrelief.com, brings all her expertise to a global audience, incorporating exercises, self-care techniques and integrative tools to maximize female healing and professional training. After suffering from pelvic floor dysfunction herself after the birth of her daughter, Isa has made it her life’s mission to help 1 million women overcome pelvic floor dysfunction.
Welcome to the show, Isa Herrera. Such a pleasure to have you.
Isa Herrera: Thank you so much, Ari. I’m super excited to have this conversation with you today. Thank you for having me on your show.
Ari Whitten: Yeah, it’s nice to connect with you again. On a personal note, we got to know each other and see each other and meet each other in person. I think it was a few months ago. Was it October that we were in Cabo San Lucas?
Isa Herrera: Yeah, October in Cabo San Lucas. It’s always nice to meet everyone in person. It was just a big get together, a big pow-wow with everyone. It was nice.
The biggest issue in treatment of pelvic pain
Ari Whitten: Yeah, it was great. I really enjoyed talking to you and your husband. This is kind of a niche topic, right? I t’s obviously women-specific, but within that, it’s a very specific thing of treating pelvic floor dysfunction and other pelvic issues. And this is not a thing that is commonly talked about in health circles, but I think it’s a really common problem that just isn’t being addressed very thoroughly. I’m curious how you got into this and the background story of what made you specialize in this.
Isa Herrera: Sure. Thank you for asking that question; it’s a great question. I was in PT school (I’ve been a personal trainer for over 30 years), and I did that, and then I went to PT school to learn more about women’s health. Then when I got to PT school, there was like a one-hour lecture on women’s health.
It’s really ironic. While I was there, I got pregnant and so I’m at PT School, I’m pregnant, and I’m thinking I know everything. I’m working with people, I’m working on the body, and then I have my baby and I had no idea the things that can happen to your body when you have a child. And it really took me by surprise because I was ill equipped to help myself because I had no idea that (and maybe I was living in a bubble) you can actually have trauma to the pelvis, you can have scarring to the pelvis, and you can have different kinds of issues.
I had incontinence, I had pelvic pain, I had SI joint pain: you name it. I had the full gamut. And every time I went back to my doctor, he would say, “This is a normal part of healing.” So I would be okay, then I’d go back, I’d be like, “I’m just healing and it’s going to take time.” After the third time of going back to my M.D., I realized that something was very terribly wrong and that he was not going to be the one to help me.
Then I went on a mission. I’m like, “Well, if this is a muscle like every other muscle my body, let me apply the principles that have already learned to heal my own pelvic floor muscles.” And that’s what I did—I took every class that I could take. I scoured the internet as Doctor Google for a while, and at the end I came out of it ahead, but I was on what I call my personal doctor roadshow where I was taking painkillers and nerve suppressants, and ambient because I couldn’t sleep because of the pain, and this was the secuela of my journey. And one day I just had this moment, and I was like, “No, I don’t want to live like this anymore. I don’t want to do it like this anymore.” Then I just stopped everything, cold turkey, and I started to apply more holistic exercises and massages, and different kinds of things that I already knew, and making that deep connection to my pelvic floor.
Ari Whitten: Very interesting. And then you transitioned into teaching.
Isa Herrera: Yes, I did. I taught at Hunter College, and they wanted me to teach marketing techniques because that’s one of my specialties: how to market a practice. And I said, “I’ll teach that if you let me teach about pelvic health. Otherwise I’m not doing it.”
Ari Whitten: So that was at a school for physical therapists?
Isa Herrera: Yeah, for physical therapists, for doctors of physical therapy, and it was really interesting because when I was teaching the students, they also had no idea. It was like all these light bulbs were going off in the classroom, and it was really nice because a new generation of PTs that did have to go through what I went through knew about how to help women when they came to their offices. I thought that was like a full-circle experience.
How common pelvic floor dysfunction really is
Ari Whitten: Excellent. So, I’m curious, how common is this for women? How common of a problem is various kinds of pelvic floor dysfunction?
Isa Herrera: Oh, it’s very common. Thank you for asking that, Ari. Let’s just talk about chronic pelvic pain. We have 30 million women in the US alone suffering from this: that’s one out of three. That’s a significant number. That’s like out of every three people we know, one of them has something.
I was taken aback by the volume of women who suffer, sometimes in silence. We have older women, 49% percent of them have pelvic organ prolapse, which is when the muscles themselves can’t hold up the internal organs. We have another 50% of women who have incontinence. We have 37% of athletic women—we’re talking about collegial levels, really in shape—who suffer from incontinence or fecal incontinence. I think the problem is huge. I think that there’s a lot of shame and a lot of silence around it, and I think that the more women start to tell their stories and talk about it and seek help and learn how to care for themselves, it’s going to change everything for the better.
Ari Whitten: Follow-up question on that: why is this common? What are the causes of why pelvic floor dysfunction has become such a huge issue?
Isa Herrera: I think maybe it has always been around, but now we have a label for it, so now everybody’s labeled. One of the things that I find is the trauma to the pelvis, which is really obvious. Obstetrical trauma or just childbirth in general. Cesareans can be a big issue for pelvic floor dysfunction. I think sitting is the new smoking. When you sit a lot in a rounded, slouch position, the pelvic floor muscles become tighter, and when they become tighter, they get tight weakness and they become weak. Traumatic falls to the coccyx are another reason. 96% of women who have pelvic floor dysfunction also have lower-back pain. So that’s interesting because what we have to remember is that the pelvic floor is centrally located.
It’s deeply connected to everything in the pelvis and in the body, it connects the lower extremity to the upper extremity, so it’s influenced by an array of things outside the body. Women with total hip replacements typically suffer from pain; not only pelvic floor dysfunction but also scar pain. That’s really the gamut of it. I think that a lot of what goes on is that people think that it’s a psychological disorder or sexual dysfunction, but it’s really a physical issue, and once we wrap our minds around the fact that it’s a physical issue, then we treat the physicality of it.
Ari Whitten: A second ago you mentioned sitting as one of the causes. Since I’m kind of more of a naturalist in my thinking and my philosophies of health, what intuitively came to mind as a potential cause of pelvic floor dysfunction is maybe not only the lack of movement and physical exercise in our daily lives, but sitting and, specifically, not having to get up and down from the floor as much and not sitting on the floor or not squatting when you defecate but instead sitting on the toilet. I’m curious if you feel those kinds of layers of the story are playing a role as a causal factor as well.
Isa Herrera: Oh, I believe so. Totally. 100%. I mean, let’s face it, most people have really poor bowel and bladder habits, and with the pushing that goes on with defecation and urination and the hesitancy of urination, we have a whole culture of potty training that is sometimes a little bit aggressive, and people tend to tighten up. And with the pushy and the poor body mechanics with bowel and bladder movements, there is definitely a big correlation. Women, and men too, typically feel like they either can’t go to the bathroom or when they do go that there is still something left behind, either number two or urine. I definitely think that it’s the fact that we don’t squat, that we are sometimes in a really sort of like slouched position where we’re in the bathroom and we should be more in the squat position. That’s why I like what I call the potty posture, where you put a couple of magazines underneath your feet and then you have your knees higher than your hips, and then that really aligns everything, the intestinal-anal-rectal triangle, and then everything can come up much easier, and the muscles tend to be more relaxed in that position. So that’s a great question.
Ari Whitten: I was just thinking, when I was about 15 or 16 years old, I went to Japan for a summer. I was training with some college guys, doing martial arts there for a summer, and basically getting my butt kicked by older guys for a few months. It was sort of a rite of passage for me, but one of the things as I was living in the dorms with these Japanese college guys was you go to the bathrooms and there’s this sort of dug out little tub, and I’m like, “What the hell do you do with this?” As a 16-year old American kid, I had never seen something like that before, and I figured out that I was supposed to squat over it. These questions just came to mind: there’s probably no data on this, but if there is, you’d be the person to ask. I’m curious if they’ve looked at rates of pelvic floor dysfunction among women in different populations, and I’m wondering if you could see something like a significant difference in the rates of pelvic floor dysfunction of various kinds in a place like Japan or one of the other countries where they’re commonly sitting on the floor and they’re squatting when they defecate. I’m curious, have you seen any studies like that?
Isa Herrera: Not about this particular topic. It’s a great question. I’m not sure. I don’t want to answer that, but if you think about it logically, if you are more in a squatting position and the muscles are more flexible and everything is in better alignment, then you would think that if that’s their lifestyle, then they’re going to have less dysfunction. That’s one correlation of dysfunction, but then it depends on how their birthing in their community, whether it’s something that’s done in the hospital or whether they are more midwives centric and more women are laboring at home. And then it just depends on whether it’s a big athletic population. Or is it a culture, like ours, that sits a lot? When we sit, we know that that’s one of probably one of the most detrimental things that we can do for our bodies without getting up. I mean, you see the whole wave now of people having walking treadmills now, right?
Isa’s take on kegel exercises
Ari Whitten: Yeah, I’m on one right now, actually. I’m just not walking because it distracts people when I move too much. So let’s talk some specifics. I know you’re not a fan of kegels. Why not?
Isa Herrera: Well, it’s not that I’m not a fan of kegels (it’s an excellent question), but I’m more a fan of having balance in the pelvic floor. I think that when you’re doing a kegel exercise, you want to also have the balance and creative a reverse kegel, and 25% of women (this is what the literature shows) doesn’t even know how to do a kegel. Then we go to our fitness trainers, we go to our pilates individuals, we go to different kinds of caregivers and they instruct us to do kegels because they feel that kegels is the Nevada of pelvic power; that it’s going to take you to the finish line. But what’s going to take you to the finish line is to have a balance of strengthening and relaxation and actually doing the exercise in the correct way. So because so many women do kegels incorrectly, and so in many women hold so tight in the pelvis, they have to learn to release and let go. As you know, when you’re holding on too tight, circulation decreases, there’s more tension, trigger points and spasms. I like women to first learn how to release and let go, open up, and then incorporate the strengthening part.
Ari Whitten: You said a reverse kegel, right? How do you do a reverse kegel?
Isa Herrera: Okay, I’ll tell you how you do a kegel first since your audience might want to know this, and then we’ll go into reverse, which is the opposite. So when you’re doing a kegel, you’re looking for three things. The clitoris should not, the perineal body, which is the area between the anus and rectum, should contract and the anus should retract: everything is pulling up and in, and you do that as you exhale. And when you’re doing a reverse kegel, you’re actually opening up the whole pelvic area, and you do that with an inhale, so you’re sending the breath much lower than a diaphragmatic breath. You’re sending the breath into the pelvis and we’re working physiologically, we’re working with the rhythm of the breath to get the muscles to open up. I like to tell women to imagine that their pelvic floor area is a sunflower blossoming in the springtime, and it’s opening, and it’s letting go and it’s gentle and it’s supple because we know that if we have flexibility, then we’re going to have the counterpart, which is the power, and everybody wants orgasmic power, everybody wants to have a great sex life, but we are sometimes missing that tenderness that we need to treat ourselves with, and I think the reverse Kegel is all about that balance.
Ari Whitten: Yeah. Something you just made me think of is the Valsalva maneuver. Are you familiar with that? [Isa: Yeah, of course.] Creating that intra-abdominal pressure and pushing out, does practicing something like that have any benefits for pelvic floor function?
Isa Herrera: I mean there are some people that believe that you can do a Valsalva and engage the pelvic floor, but what I believe is that when you Valsalva and you hold your breath, you risk not only creating some pain in your lower back, but what also happens is that you create too much intra-abdominal pressure and that pressure affects the pelvis and then the organs, your bladder, your rectus, your uterus; the things that the pelvic floor supports become more stressed out, and then you can prolapse, which means, the organs fall into the vagina and there’s various degrees of that. I am not a big fan of a Vasalva. I like more natural breathing and coordinating the breath with an exercise the same way that you would do when you go to the gym and work out, where if you’re holding your breath, you’re probably going to get into trouble.
Ari Whitten: Yeah. Maybe it’s actually worth talking a bit (this is kind of stepping back, maybe we jumped ahead too much) about an overview of what the pelvic floor actually is and what it does.
Isa Herrera: Sure. This is a great question because everybody always asks me this question. I got this one down. The pelvic floor is sort of the connector, the deep connector; it’s the first chakra if you believe in energy: it holds all the other chakras. It is the seed of creation. What the pelvic floor does, it has five functions, and I call them the five s’s of life. It has a sexual function, so if things are going bad, orgasms are going to peter out, or the orgasms can be nonexistent. It has us a syntonic function, so it closes off the sphincter so we don’t leak on ourselves and we don’t have fecal incontinence. It has a supportive function, and basically it supports all the organs. I mean it’s the basin. It’s like a cradle, and in that cradle is all your organs. It’s got a stabilization factor. I think one of the things that happens with athletic women is that the pelvic floor could be too tight, so it’s weak and is not stabilizing the lumbar, the hip and the sacrum. So athlethic women get into trouble that way, and then the pelvic floor gets too tight. A lot of people don’t get that if there’s back pain, if there’s sciata, if there’s joint pain, then you have to work the pelvic floor so that you can hold everything better. And then the last is sump pump. It has a lymphatic function in the pelvis; it pumps fluids around. And sometimes, when women are very tight, there’s a decrease of circulation in the pelvis. And now everyone is using the catch-all phrase called pelvic congestion. I think when we can’t figure it out, we just say it’s congested. Those are the functions of the pelvic floor. And because they have such a diverse function, they can really have a deep influence on our gate, the way we hold our body, on our pelvic alignment, on our sexuality, and ultimately, if you are suffering, on our mindset, on our psycho-spiritual level because if you’re out of sorts there, then you’re going to be out of sorts in other places of your life.
How to protect your pelvic floor
Ari Whitten: Yeah. So, we’ve talked about what the pelvic floor is and what it does. We’ve talked about some of the main causes of pelvic floor dysfunction and why it’s prevalent. We’ve also talked about kegels and reverse kegels. What are some of the other big factors to help women protect and improve the function of their pelvic floor?
Isa Herrera: That’s a big question. I’m going to answer that as best I can. I think one of the things is really being aware of what’s happening. We’re used to tracking what’s going wrong with the body. You go to the doctor, keep a pain journal: “Hey, keep up keep this journal.” I like to do two-fold; I like when a woman undertakes a certain exercise program. I want her to really pay attention to her pelvis, and I want her to know what exercises feel good for her so that she can continue to do those and exercises that she’s leaking with because many women go to the gym, they have improper mechanics and then they leak on themselves and they ignore it, and they think that it’s a normal part [of working out]. I think journaling is the first thing so you can become aware because awareness is the key to everything. If you become aware of what’s affecting your pelvis in a way that’s not cool, then you can fix that. I think that women need to really examine themselves and do a vulva vaginal exam and look at their own pelvic floors. I don’t think we should outsource that. We shouldn’t have to go to someone to let us know what’s happening without own pelvic floors. I think
really provides a great deal of information and then doing the kegel exercises and the reverse kegel exercises with a balance: I think that’s important. And if you have pain, then that’s the one time if you have vulvodynia or vaginismus or ??-stitis or painful bladder syndrome or anything along those lines, then I think women get into trouble because they do kegels, but that’s not the right medicine for them. You have to figure it out. For example, if you’re in pain, you’re not going to create more tension, and so you should focus on the reverse kegel. If you are leaking, you have issues related more to supportive function of the pelvic floor, then you might consider doing a kegel- reverse kegel combo, so that you have balance. That’s important. I think sitting posture is important. The way you walk is important, but sitting posture is absolutely critical.
Holding your breath and not pushing during urinating and defecation are things that you can start right away and that would help you protect your pelvic floor. Not holding your breath when you’re in the gym and creating more excessive intra-abdominal pressure; I think that’s also a big thing that you have to be aware of when you’re working out. And if you’re running and you’re having any kind of issues with leaking or any kind of issues with pressure, then you have to do activity modification, because if you’re listening to your body and then your, and then there’s something going on with the body that’s giving you pelvic symptoms, whether it be leaking or pain or prolapse or pelvic discomfort, then you have to be thinking that maybe your body is not ready for that activity, and you need to strengthen other parts of it. If you heal the body, you’re going to heal many aspects of your life. You really want to be paying attention to what’s going on with that.
How you need to approach pelvic health after a cecarean
Ari Whitten:Excellent. A couple of other things: one is caesarian births and the other one is diastasis recti. I’ll let you address those however you want, but are there any sort of specific strategies that people in those scenarios need to be aware of if they’ve had a cesarean or if they have diastasis recti? What kinds of things should they do in that circumstance?
Isa Herrera: Okay, that’s a wonderful question. I love that because a lot of people feel like they have a cesarean, they’re pelvic floors are going to be 100% beautiful and that nothing’s going to happen. But what we have to remember is that there are nine months of pregnancy; there’s a lot of pressure on the pelvic floor, so there has to be some sort of attention paid to the muscles. The other thing is that the abdominal fascia and the pelvic floor fascia, they’re like a peanut butter and jelly sandwich, and when you have a cesarean, eight layers of fascia are disrupted; if there is a disruption of the fascial system, then you know that the pelvic floor is going to get it too. A lot of women come to me with cesarean births and they’re like, “I don’t understand. I didn’t birth through my vagina.
Why do I have these symptoms?” And I’m like, “Well, chances are that you have scar tissue sending wrong messages to the pelvic floor. And on top of that, the fascial system is off and on top of that, your core is weak, and maybe you don’t have the core strength that you used to because the abdominals need more work. And with the diastasis-recti separation it is the same thing; diastasis-recti separation has been correlated with sexual pain in the literature, lower back pain, leaking and prolapse because there’s nothing to hold the organs together because the pelvic floor and the abdominal muscles, they love each other. They have a synergistic relationship: they work together. [Ari: They’re like peanut butter and jelly.] A peanut butter and jelly sandwich. And even though I don’t think I’ve had a peanut butter and jelly sandwich in about 50 years, but they are like that and they have this beautiful relationship, so when the core is weak, you’re going to get it in the pelvic floor, and when the pelvic floor is weak, the abdominals are going to respond. So it’s best to work those two body parts together.
Ari Whitten: Excellent. We’ve addressed everything, I think. Is there anything that comes to your mind as far as another topic that you feel like we haven’t covered?
Isa Herrera: No, I think you are an excellent interviewer. I think you got everything out of it.
How you should approach a UTI
Ari Whitten: Are there any bladder-specific issues that you want to talk about? Let’s see, we covered what the pelvic floor is and what it does. We covered main causes of dysfunction. We covered some of the key strategies to improve pelvic floor function. We covered cesarean diastasis recti. Is there anything else that we haven’t mentioned here?
Isa Herrera: Yeah, I think one of the things that I would like to bring some awareness to, and you struck a light in my brain, is when there’s a UTI, or when there’s itching and burning in the vagina, not to go and hit the bottle of antibiotics right away because antibiotic use does affect the pelvic floor, it affects the floor of the vagina, but sometimes if the pelvic floor has a tear in it from a burst, some sort of trauma, if it’s tight, if it’s got trigger points of spasms, you can get symptoms that feel like you have a bladder infection; they feel like you have a yeast infection. I’ve treated thousands of women have come to me, tell me that they have a yeast [infection], and I’m like, “Check it out first because I don’t think you do.” And I say, “Don’t go for the antibiotics right away because then that destroys everything. It’s best to always get yourself checked out first to make sure before you proceed with a course of antibiotics for symptoms related to female conditions.
Ari Whitten: Okay, so just to clarify that: people are having symptoms, women are having symptoms. I’m using the word “people” to try to be politically correct, but men are… [Isa: No, men have them too.] Men don’t have vaginal yeast infections though.
Isa Herrera: No they don’t. But they do have a lot of issues with their bladders I’ve treated tons of CEOs for that.
Ari Whitten: Yeah. Women are getting a scenario where they’re sensing symptoms of, let’s say, a yeast infection. And you’re saying that it might be pelvic floor dysfunction?
Isa Herrera: 100%. And I can’t tell you how many women have come to me and have taken antibiotics and then taken an antifungal, and have created a worse situation for their vaginas. And now we have to deal with the circumstances of those drugs in the body.
Ari Whitten: So, let’s say it is pelvic floor dysfunction. What would you recommend in that circumstance to a woman who’s dealing with what she thinks is an acute yeast infection?
Isa Herrera: If it’s an acute yeast infection, go to the doctor, make sure it’s an infection. If it’s not, it will all test negative, and then I totally recommend seeing a pelvic floor physical therapist who can help diagnose what’s going on in the pelvis. And then to understand that you also have to know your body and you have to know how to care for it. Those are the most important things that I would do. And you can always take one of my online programs too, to figure out how to have excellent self-care techniques for the pelvic floor, and I think that just checking yourself out before you take pain meds (because I’ve been on here and I’ve treated thousands of women with this kind of condition) because sometimes the side effects of these drugs is much worse and then it compounds everything. I always like everyone to know for sure, and now they have these things over the counter that you can check with.
Ari Whitten: Yeah. Excellent. Where can people find out more about your work? Where can people follow you and what do you have? I know that we mentioned in the bio that you have an academy, an online school for women, who want to improve their pelvic floor health. Do you want to tell people a little more about where they can get more of your work and follow you?
Isa Herrera: Sure, thank you for asking that. Just go to pelvicpainrelief.com. You can find all the information that you need there. There are links to my Instagram and Facebook: I’m all over the place. It’s my passion to put this information out there. Pelvicpainrelief.com, really nice and simple. Everything you need is right there.
Ari Whitten: Okay. Awesome. Wonderful. Thank you, Isa. Thank you so much for coming on the show. I really enjoyed this, and I think it’s much needed information for a very important and very common problem that just really isn’t being addressed very well. So thanks so much for coming on the show, and it’s such a pleasure to talk to you, as always.
Isa Herrera: Thank you so much, Ari, I really had a great time. Thank you so much for having me.
How to Fix Pelvic Floor Problems (Pelvic Pain, Leaking, and Prolapse) with Isa Herrera – Show Notes
The biggest issue in treatment of pelvic pain (4:44)
How common pelvic floor dysfunction really is (8:58)
Isa’s take on kegel exercises (17:13)
How to protect your pelvic floor (23:40)
How you need to approach pelvic health after a cesarean (26:55)
How you should approach a UTI (29:35)
To get help with improving your pelvic floor health, check out Isa’s free masterclass: PelvicPainRelief.com