By Coach Dafne Alayon, PhD.
Dr. Toro is a wonderful pelvic floor specialist who works right here in Westchester! I was lucky enough to be connected to her after experiencing labor-related complications. The benefits of working with such a kind, compassionate, knowledgeable, and sensitive doctor are many. She helped me work through the huge emotions I was feeling about the changes that happened to my body, and gave me hope for change. She was available to guide me through my panic when symptoms flared and my worries spiraled about how my future was going to look. She also gave me incredible symptom relief. As a seasoned pelvic floor specialist, she was able to feel for areas that were tight, in spasm, and relax them in order to make my body feel good again. I highly recommend that women (and men) at least see a pelvic floor PT like Dr. Toro once to get a sense of how they’re doing and what they can do to stay strong throughout their lives. And, if you ever have any concerns or symptoms, they’re the experts who can help you get strong and live better!
Dafne: I have been approached by several people who want to know what the pelvic floor is. Can you explain briefly what it is and what it does?
Dr. Toro: The pelvic floor is a group of muscles that creates a bowl attaching to the bony surface of our pelvis, creating support for all of our organs including the bladder, rectum and abdominal organs. In women, it is especially important for providing external support to our reproductive organs. Part of these muscles are attached to the coccyx, the base of the spine, which is why it can sometimes contribute to lower back pain. Often overlooked, the pelvic floor forms the foundation of our core, revealing its importance when symptoms arise.
Dafne: What are some common symptoms you see in women who have pelvic floor issues?
Dr. Toro: Pelvic floor dysfunction can manifest in a variety of ways, ranging from tightness that causes pelvic pain, such as during menstruation or intercourse, to difficulties with completing a bowel movement or emptying your bladder. Weakness of the pelvic floor can cause urinary leakage, such as with sneezing or coughing, as well as the sensation of heaviness or pressure associated with a pelvic organ prolapse. Symptoms can even extend to constipation and accidental passage of gas, the latter of which can be the first symptom of fecal incontinence. Yes – passing gas during downward dog is not normal!
Dafne: What can happen to our pelvic floor over the decades if we don’t take care of it? How do changing hormones impact our muscular strength/recruitment?
Dr. Toro: Just like any muscle, if you don’t use it, you’ll lose it! Over the years, especially after the hormonal shifts that follow childbirth, the pelvic floor can become overstressed. As we age, decreased blood flow can lead to muscle stiffness and atrophy, making it crucial to stay proactive in maintaining this essential support system.
Dafne: I know there are some pleasant additional side effects of working on your pelvic floor, like better orgasm. Can you tell us a little bit about this? And is this limited to women?
Dr. Toro: Absolutely! Engaging with your pelvic floor through targeted exercises not only boosts blood flow and muscle tone, but it can also make for a better, stronger orgasm and enhance lubrication. Conversely, learning to relax these muscles can reduce friction and pain, allowing for deeper penetration. This is not just limited to women, being able to have a better understanding of your pelvic floor helps with overall motor control which can help with a stronger erection and ultimately a more gratifying ejaculation.
Dafne: What do pregnant women need to consider if they want to take care of their pelvic floor?
Dr. Toro: During pregnancy, our bodies are constantly going through changes, many of which are occurring behind the scenes to accommodate a growing baby and expanding uterus. Many women sail through pregnancy, only to encounter unexpected symptoms postpartum. The pelvic floor undergoes tremendous changes over 40 weeks, by caring for this area during pregnancy—whether to alleviate discomfort or prevent complications like perineal tearing and pelvic organ prolapse—the body is being set up for a quicker and easier recovery so that women can more easily adapt to both physical and mental changes experienced in the postpartum phase.
Dafne: Most of the time, medical doctors tell pregnant women to continue doing what they were before, but to be cautious about adding extra activities. What are your thoughts on women beginning new exercises during pregnancy?
Dr. Toro: Women can absolutely begin new exercises during pregnancy! As posture shifts and ligaments loosen, engaging in a variety of movements can help build strength and stability, setting the stage for a more able and active body. Keeping realistic goals and expectations about movement and how certain movements need to be adapted as one progresses during their pregnancy, can help to establish a healthy routine and ultimately a healthier body. The postpartum phase encounters a lot of new changes, and these changes make it difficult to establish consistency, so sticking to a routine during pregnancy can help make this transition easier!
Dafne: What are your thoughts on lifting weights while pregnant?
Dr. Toro: Weightlifting during pregnancy is not only safe but can be incredibly beneficial! If you’re new to lifting, start slowly and listen to your body. If you feel unsure or overwhelmed, seeking professional guidance can help you navigate this journey confidently and effectively, minimizing risk of injury. As always, check with your healthcare provider first before beginning any new routine.
Dafne: What are the best steps for women to determine what their pelvic floor needs/what exercises to focus on to keep strong?
Dr. Toro: While I may be a bit biased, seeing a Pelvic Health therapist is the best way to assess your pelvic floor’s needs. Whether it’s tightness or weakness, diving straight into kegels without understanding your unique condition can lead to discomfort. A professional evaluation ensures you’re taking the right steps to enhance your pelvic health.
Dafne: Sometimes different life experiences impact how our bodies feel, respond to stress, or touch. Can you share some examples where certain important experiences came up for patients while working on their bodies?
Dr. Toro: The pelvic floor is one of the biggest storage spaces for emotional trauma. As we work to release physical tension, it’s not uncommon for emotions to surface. Without addressing these feelings—whether related to past abuse, labor trauma, or even stress from life changes—full healing cannot be achieved. It’s essential to recognize the connection between our experiences and physical health.
Dafne: How can manual treatment help women process the emotional things that have happened to their pelvic floor (e.g., prolapse after childbirth?)
Dr. Toro: Many women shy away from connecting with their bodies after childbirth, avoiding looking at or even touching their vulva. Manual treatment can help women to reclaim a sense of empowerment and control during this time. By working with a pelvic floor therapist, women can better understand their bodies which helps to navigate changes after birth, increasing a sense of control during a time of uncertainty (and sleep deprivation). I encourage women not to wait until it’s too late, as some symptoms don’t spontaneously resolve on their own or can resolve faster with intervention. Taking 1 hour out of your week to work on your own body can actually feel very relaxing, stepping away from your routine to focus on your own healing can help to break up the day to day monotony.
Dafne: What can someone expect from a session with a pelvic floor specialist, and what if they feel nervous or embarrassed?
Dr. Toro: Although the patient can refuse, an internal vaginal exam gives a pelvic floor specialist the most detailed information about pelvic organ support, muscle strength and motor control. The only way to palpate the pelvic floor is internally, and for men this is done through the rectum. This may seem daunting at first, but the immediate changes you will feel, often after just one session, make it worth it. I always tell my patients, they are in control – always, if they ever feel uncomfortable or want the session to stop then I will stop immediately. I also make sure that patients know that they are an active participant during the exam which is crucial for the pelvic floor whether it be during a time of strengthening or a time of releasing spasms within the muscles. I describe everything I’m doing in real time and if I see that the patient is becoming a passive participant and dissociating from their body, then I immediately end the exam. It can feel overwhelming, which is why a pelvic floor therapist will meet you where you are and work based on your timeline of how your body responds. Also there is never a need to feel embarrassed! During the exam, maintaining modesty is always a priority. A pelvic floor specialist does not care (or even notice) if you are shaved, waxed or all natural! Lastly, there is no speculum or stirrups used, the person should feel as comfortable as possible in their position of preference.
Dafne: Is it normal to pee a little (or a lot) when jumping rope, doing box jumps, or running?
Dr. Toro: No this is not normal! It may be common but it is not normal. I think the media has really normalized this over the years in movies and in phrases such as “laughing so hard I peed my pants”. Peeing with activity indicates that your pelvic floor may be struggling to handle the stress of those activities. Addressing this issue often starts with breath control and pelvic strengthening, gradually preparing your body for higher impact without leaks. It takes 6 weeks to begin to build muscle, so be patient and allow your pelvic floor time to catch up with the demand of higher impact activity.
Dafne: Is it possible to treat peeing while exercising?
Dr. Toro: Yes, definitely! It takes time and patience to gradually build up the strength to accept increasing loads and forces encountered during exercise. Starting in a gravity-eliminated position (such as laying on your back) allows for isolated recruitment of the pelvic floor and improved motor control, before ultimately moving to more functional positions such as with standing and jumping exercises.
Dafne: Do men have pelvic floors? Should they be concerned about their pelvic floors? Why?
Dr. Toro: Absolutely, men have pelvic floors, and they deserve attention too! Men have longer urethras and don’t go through childbirth so oftentimes they may not experience urinary symptoms until later in life but it can still be an area of concern. Common issues that can stem from pelvic floor dysfunction include erectile dysfunction, painful urination and constipation. Additionally, conditions like prostate surgery can increase the need for pelvic floor care. Everyone’s pelvic health matters!
