Season 3, Episode 12: Sex & IBS

Welcome back to The Gut Show! I'm your host Erin Judge, and I am thrilled to share today's episode with you and our special guest, Dr. Kelly Peterson. Kelly is a Doctor of Physical Therapy that specializes in pelvic visceral and orthopedic physical therapy. She currently practices at an outpatient clinic in Huntington Beach, California, but also has her own business that provides worldwide online consultations, digital content, and in person services as The Belly Whisperer in Orange County, California.

I've been following Kelly on social media for a while, that's how we originally connected and one topic that she always hits on with her content that we cover today is about sex and IBS and digestive issues. So we're going to talk about why there are certain concerns and maybe even some discomfort with sex that can overlap with digestive issues and disorders and then what you can actually do about it so that you can live your life however you want to on your own terms!

Enjoy today's episode and after you listen, connect with Kelly, connect with our community at The Gut Community and let us know what you thought or any additional questions that you have.

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Erin Judge: Kelly, thank you so much for being on the show! I want to get started by just hearing a little bit more about your story, like who are you? Why are you in pelvic floor pt and why do you do what you do?

Dr. Kelly Peterson: Thanks for having me, I'm really excited! So my name is Kelly Peterson. I'm a pelvic floor physical therapist, I specialize in pelvic visceral and orthopedic physical therapy. So I have my doctorate in physical therapy, but I underwent certain certifications to do visceral manipulation for you know, your organs, your abdomen, as well as the pelvic floor therapy. So I live in Orange County, California and right now I work in a clinic, treating patients orthopedic and pelvic floor and visceral. And then I also have my own business, The Belly Whisperer, you know, program method, all of that. And I treat people privately on the weekends, and I do online consults, which is great because I find that a lot of people don't have any resources where they are, especially like other countries, and even different areas in the US, it's very limited for people that have, you know, gut disorders, pelvic floor disorders, so I found that it's been amazing, like meeting the people, patients, all of it.

Erin Judge: Yeah, absolutely. And that is interesting how hard it is to find a specialist, we see that a lot with our clients trying to find the right people to help them out. Or even the right people that have the wealth of experience with the different areas of pelvic floor PT, because that's even more involved. Why did you choose pelvic floor PT as a specialty or even the visceral work? Like why did you decide to go into those specialties?

Dr. Kelly Peterson: Yeah, great question. It's funny, because, you know, I kind of stumbled upon it. I was going through clinical rotations during PT school, and I was at an outpatient orthopedic clinic. I had a clinical instructor who actually was learning visceral techniques and he had taken visceral courses. I had never really learned, they kind of talked a little bit about it in school, but I hadn't really learned it. He was basically showing me all his books, and kind of showing techniques and I was like, oh, I've had my gallbladder removed, I have IBS, I have ulcerative colitis, you know, I have all these things and I had never even thought that, you know, there was manual techniques or specialists that actually helped with that. So when they did techniques on me, I remember coming back the next day being like, where are your books? I want to read everything, like this is incredible, why isn't this taught more, right?

After I finished those rotations, I finished school and I passed my boards, I decided I wanted to take more classes. So I went to the Barral Institute and I took all of their visceral classes and loved it. I felt that it was such a big benefit for my patients in the clinic and, you know, even for myself, and then what I realized was, you know, I was still having so many patients with lots of pelvic floor issues, and these people would be coming in for like, frozen shoulder, a hip replacement, maybe they had falls, right, a lot of elderly with incontinence leaking. It was incredible how many people just coming in for general orthopedic injuries, had pelvic floor dysfunction, kind of marked in the medical history. So I thought, Alright, let's, let's see what's going on with this. And then again, same thing, I took the courses, I went through Herman and Wallace Institute and I took all of the first three courses on pelvic floor, and I just fell in love with it, it was like, almost like this whole full circle kind of coming together and then again, once I learned all of that, and started implementing it in my life, with like, my IBS, I couldn't believe how much better I felt.

I have IBS, I started having issues, I'm 31 now and when I was 18, that's when everything kind of started happening for me. And it took me a long time to kind of overcome all of that and I you know, with diet, diet changes, I went gluten free, I had a gluten intolerance, you know, medications for a little bit, but then I got off with them. So it was kind of like trial and error, like a lot of us who go through gut disorders, not really knowing what's going on. But like, learning all of those things, and then applying it even that, like far out, I couldn't believe how much better I felt and like things that doctor said, oh, this is normal, like you're gonna have this fear for the rest of your life. I was able to get rid of right, like, you know, bowel and bladder habits.

And we're gonna I know talk a lot about that like things during sex, you know, things with putting in a tampon things that your doctor maybe told you, well, that's normal, because you have IBS. And for me, I like to tell people like, I know, it can be triggering to hear like, you know, normal, it's common to have those types of issues pain with sex when you have constipation or IBS, but it's treatable. And that's like, my whole mission now is to help other people because it's been huge in my life. And it's funny because looking back now, I think it was like I was always meant to do this. So it's just funny because I never went into, I always knew I wanted to help people and go into the medical field, but I never had thought I would be actually doing something where it hits home so much. I just love it. So it's probably one of the reasons why I work too much, but it's rewarding. And I'm sure you feel that same way as a dietitian.

Erin Judge: Yeah, absolutely, definitely. It is fun whenever your work doesn't necessarily feel like work, like it is a lot of work but it's also fun and exciting. And with learning so many new things, I feel like there's always something new and creative and you know, unique because every single person is different. Every person you work with is a new challenge, that's also a positive outcome for everybody. That's so great that you, I think, whenever we're looking at pelvic floor PTs, a lot of times the focus primarily is on postpartum, you know, issues and delivery, right. And so we see that often, I've had clients who say, oh, well, you know, I've looked at this person, but it seems like it's all really geared towards pregnancy or postpartum care. What drew me to your account into your work, is that, yes, that's a piece of it, but the focus on digestion was so strong, and like really putting that forward and kind of at the forefront is such a big deal. Did you do that intentionally or is that more because of your own personal history and just what you were focusing on yourself?

Dr. Kelly Peterson: No, that's exactly what I did it because it's something that I found that there weren't a lot of resources out there, I didn't see a lot of pelvic floor physical therapists or other specialists kind of talking about the visceral techniques, even though I met people when I did my courses, but people weren't making it more public or accessible. And also, it is so awkward to talk about these types of things for a lot of people, it's uncomfortable sometimes for even the medical professional. Luckily, for me, I enjoy talking about them and I think that's helpful for my patients because one of the things I hear from people is, I just feel so comfortable, I can tell you anything, and I love that, because I do want people to feel that way. But I think it's an awkward thing to talk about. Right?

I was reading a, like, I was reading some research papers on like, IBS, and one of the things that it was saying was a lot of people get diagnosed, you know, by a gastroenterologist that they have irritable bowel syndrome, maybe celiacs, Crohn's disease, and then they get kind of sent down the medication path, or maybe they need surgery or some type of intervention by that doctor, but the doctor doesn't really talk about, like, the mental toll that's going to take on you, they don't talk about the sexual kind of impairments that you may have, right, the, you know, the intimacy with your partner. And I think that's a problem because people will get a diagnosis all the time, I hear patients tell me, my doctor diagnosed me with stenosis or, you know, diagnosed with arthritis and meniscus tear, and all these big words, and people just leave totally freaked out and then that, you know, it also increases their stress and makes their symptoms worse, right? You know, more than anybody stress is such a trigger for IBS and so that's why I think I gravitated toward, you know, I didn't intend to be so blunt on my social media, like, I wanted to keep it professional, it's kind of hard, you know, you want to get out there and talk to people, but you still want to keep it professional. But when it comes to sex, sometimes you just kind of have to be honest, and, you know, share your own experiences. And I think what I found is so many people can relate, and I've had so many people reach out to me, oh my goodness, I have this issue, I didn't know there was a way to treat it.

So yeah, that's kind of how I kind of got into it. And it's also nice, too, because as you kind of treat more people and people send you messages and comments, it kind of helps you be like, wow, I really need to talk more about this, like I did a webinar on painful penetration and sex and I couldn't believe how many people signed up, and then even bought it after because so many people suffer, I think in silence from painful penetration. And again, a lot of people that have IBS or gut disorders, like, you know, constipation, all of that have difficulty with sex. So it's just a huge, I think there's just like a huge lack of resources for those people.

Erin Judge: Yeah, no, I agree and I get asked about that, too. Sometimes it's like, well, that's not my specialty, that's a highlight of like, you know, there are people aren't asking their doctors about it as much as they could, or if they do, doctors don't know, and you may be brushed off, I'm not really sure what they're doing. But, you know, we see that with nutrition where like, you know, a provider may say, oh, well eat more fiber, oh, you know, do the low FODMAP diet or, you know, drink more water or whatever. But they're also not assessing for what they're currently eating. They're not assessing for disordered behaviors with food, they're not assessing for, you know, if the patient hears, oh, well, you know, eat low FODMAP and then the patient needs nothing for you know, six weeks because I have no idea what to eat. It's like, they're not assessing for that. And they're not meant to, they have 15 minutes with a patient. They're meant to diagnose, they're meant to, you know, medically treat in that way, and so that's where coordinated care and you know, referrals are so valuable.

And we believe it on our team, we try to get a pelvic floor PT and every time we round the corner because we know that like posture, you know, straining, leaking, you know, sex, like, even evaluating that from all angles and not just saying like, oh, if you put a tampon in, it doesn't hurt, you know, but other things that maybe we wouldn't know to even ask. And so getting into that line, that's gonna be our conversation. We have another episode this season all about pelvic floor so if you're like, oh, wait a second, what exactly is the pelvic floor like, where are all these muscles? Pause for a moment, go to that episode so that you can get the lowdown because this episode, we are going to get all into the whole sex with IBS conversation, what to do, and tips, how to get help and all of that.

But what kind of questions would you ask if someone's like, well, I don't know if my pelvic floor is an issue, you know, maybe I have some of these other concerns, but I'm not necessarily putting them together as being connected. What are some of the questions or things that you would say to look for to connect those dots?

Dr. Kelly Peterson: Yeah, a lot of people don't realize, again, like they have pelvic floor dysfunction. And a quick way to like, identify what your pelvic floor is, if you just go underneath your bottom, if you're sitting and you feel your sit bones, just imagine in between your sit bones, there's like a little hammock, there's a front door and a backdoor for females and then a backdoor for a male. So just kind of imagine that's what we're talking about. So typically, things that would indicate that you might have a pelvic floor dysfunction would be if you're having any type of pelvic pain, right, that's obvious if you're having pain and pain can be different things it can be sharp, it can be achy, dull, stabbing, burning, right, because of how the nerves innervate muscles, sometimes you can have different symptoms numbness even.

So there's different indicators with pain, as well as bowel habits, right, let's say you're somebody that has a bowel movement 10 times a day, right versus maybe your partner only has a bowel movement two or three times a day, those indications right changes in bowel habits, also stool right like you deal with. And same with urinary, some people have, I had a friend in PT school who reached out to me recently, who said that she never realized until she read one of my posts that you weren't supposed to push when you pee. And I think a lot of people don't realize that when you have a bowel movement, when you urinate, are you straining to get it out, versus just sitting and it should come out, because people don't realize there's such a big connection with the brain, right? The nervous system with allowing your pelvic floor muscles to relax. So and then other indicators as well are if you have, you know, other things like stressors in your life, if you're somebody that has high stressors, or you've had a traumatic experience, right, whether that's abuse, verbally, physically, those are, you know, indicators that typically you can have pelvic floor dysfunction after, and those people sometimes don't really go get help, or even their doctors don't even refer them to pelvic floor therapy, which is really unfortunate, because trauma can be stored for a long period of time and it can manifest in different ways.

Also, if you're somebody that has like excessive gas, like I'm sure you hear this all the time, like people with trapped gas in their pelvis, pressure in the rectum, pressure in your pelvic floor, those are all kind of indicators that you may be having issues leaking, leaking with working out. So different things, or you know, some people don't necessarily have, you know, any issues during like, let's say you have a bowel movement, and you have no pain, but then after you're getting pain in your rectum, you're getting burning, you know, maybe you have a hemorrhoid you don't know about. And that's another thing, too, is hemorrhoids, I find are one of the things that doctors don't refer patients to pelvic floor pt. A lot of people just think I have to live with them and they're either active or like inactive, but in reality, you know too, it's changing your habits, changing your diet, those things really affect, you know, if you're somebody that sits 10 hours a day, you're getting bad circulation to that area, maybe you're not using a doughnut or a seat cushion, you know, maybe you're not getting enough fiber or drinking enough water, like all of those things. Maybe your pelvic floor is so tight so every time you have a bowel movement, you have to push or you don't get adequate stretching, of course, you always have hemorrhoids.

So there's lots of indicators, I just don't think people put the pieces together that they're related. And then again, like, you know too, if you have a gut disorder, like celiac disease, or Crohn's disease, you know, hopefully your doctor tells you but they're there, you're more likely to get anal fistulas, you're more likely to get fissures and you might need surgeries. So different diagnoses can kind of, there's correlations between that but yeah, and everybody's so unique too, I'm sure just like with you know, being a dietitian, you may have one or two of these common symptoms, but you know, maybe not these other ones.

Erin Judge: Yeah, yeah, absolutely, and it never hurts to go get checked by a PT. So you can go directly to a public floor PT, and something that we recommend, even if our patients don't necessarily exhibit all the signs of like, oh, that's clearly a pelvic floor issue, we can see some of that where it's like, okay, the stools just there, it's not coming out or it's leaking, you know, that seems to be pretty clear, like, we need to go. But even if it's not super clear, it helps to have someone check out where you're at, and how things are going and how you know, how you're pushing and where you're connecting, because you never know what could be connected. And it's about all these little pieces coming together, where we actually see results, like you mentioned, there's a lot of layers to it, and when we get all the pieces together, we see better results, versus there being a piece that's completely missing, like the pelvic floor piece.

So whenever we're thinking about like sex, so kind of getting into issues with sex, I hear about it often from two different sides. One side is the pain or what some people consider embarrassing, but it's not, we just never talk about it, but you know, pooping yourself well, while you're while you're having sex, but there's also the almost just the embarrassment side of the shame around sex because of your pelvic floor. So the fear and that side of it, so there's two sides of this.

Why is this at play? Like why is sex such an issue for those who have gut issues? Like what are some of the specifics that cause those concerns and what are those concerns really look like?

Dr. Kelly Peterson: Yeah, great question. I was reading a research paper too, talking about when are people more likely to be diagnosed with IBS or IBD and it was showing the range of like, 15 year old to a 40 year old. So it's like, you're in such a pivotal time for someone's like sexual health and like growth. And I think, again, if you look at studies and you look at statistics, you know, more females suffer from IBS or IBD, compared to males, and then more women have like a decreased quality of life if they are diagnosed with IBS. Why? I think there's a big stigma behind women talking about bowel and bladder habits. And even though we're in 2022, I still hear people say, well, women don't fart, women don't poop. And so again, it's it's this idea that, you know, you have this issue, right? It's gross for some people, right? For someone like you and I, it's a normal part of your life, it's a daily habit. And I think one of the things I find with patients, that is the hardest thing to get over, it's not that they have anything anatomically wrong with their pelvic floor, I'll go in, and I'll say, your pelvic floor is beautiful, everything looks fantastic. Everything feels great. Maybe they have a little bit of tightness. But I'll tell them, you know, I think maybe you need to go with your partner to talk to somebody, I think you may have some fear behind wanting to have intimacy, you may be nervous, you may feel, you know, poor body image, that's a huge one for women, feeling like, you know, you're gross, that there's something wrong with you. And I think just getting over that mental hurdle, that psychological hurdle is so hard, especially for females.

And, again, just like you said, that's why I think it's still such a struggle. I think it's getting better, but that's one of the things that implement the most it's like, okay, your homework is to tell your partner when you're having an IBS flare up. And it's not necessarily, you know, you have to complain, or you have to burden your partner with your IBS. It's just a quick, you know what, I'm feeling so bloated, and you know, I'm feeling so crampy today, or, I have so much swelling, maybe you're on your period, and your IBS is even worse, just letting them know, it's such a big, it's like such a weight off your shoulders. And I talk a lot about this in my method, it's like having that support system and being able to share that because I think people keep things secret and it just, like, eats at them. It makes them worse and I'm sure you see that all the time with people with eating disorders. It's like, once people just share like, yeah, like, I've pooped my pants in public before. You know, it's like, it's okay. You think you're the only one, I think that's another thing, you think you're the only one. But again, I hear stories all the time. And, you know, you think it's gonna be the wildest story you've ever heard, but no, somebody trumps it, because we all are human, and we all be all experienced similar things. So I think that's a big issue. And I know statistically, males who have IBS are more likely to have erectile dysfunction or ed. So again, it's just, there's all again, like these sexual factors that aren't being talked about when people are seeing their doctor. So yeah, that's what I believe.

Erin Judge: Yeah, no, that's really important to think about. It's like the trust right, intimacy is built on trust and that's a huge piece. I think that also comes down to even getting support, like not just sexual intimacy, but you know, intimacy in terms of emotional connection or feeling supported, and I hear it a lot where, you know, clients come in, and typically women and men, I've heard this from men as well, I think it doesn't matter, like your gender necessarily, I think women now are talking about this more, I think men also need to talk about this more like, we all need to talk about it more. But it's this thing of like, oh, I'm, you know, there's no way I can do that, like, you know, I can't make those changes when I travel, I'm traveling with people, or I just can't talk about that.

It's like, well, have you talked about it? Like, has your partner said that they don't want to support you? Or do they even know, and we see it with family too. It's like, you know, family doesn't want to support me, it's like, have you asked for support, like, have you, you know, explained it to them. And it's not a shameful thing if you haven't, because it is easy to feel alone and not know what to do. But usually, whenever people just let down the barrier bit and share, like partners that are really meant to be there in that place like are super supportive, and it builds that intimacy and connection, because, yes, they understand what's going on. And yes, that might not be the most glorious thing in the world, that your partner knows that you're having issues in the bathroom, but it also builds so much trust between you that it does help break down those walls, so that if you are getting into, like sexual intimacy, you know, you don't know what your body's gonna do, like you don't know, especially as you're starting to figure it out, and I don't like we're gonna speak about that more to have like, what that looks like in the process because I'm sure it's not just a quick fix overnight that oh, you're tight, pelvic floor is now improved, and so no more pain, or you were, you know, leaking or pooping in the middle of sex and now that's completely resolved, it's not gonna happen again, I see that even with diets like, you might tolerate a food well, and the next day, you may not, and it's gonna take us time to build up tolerance that's consistent. But the process is only done through trust with your body, with yourself, but also trust with your partner. Do you agree with that? Is that also what you meant?

Dr. Kelly Peterson: Yes, I think a lot of people have like fear based tendencies that start to develop, and they can really get out of control if you don't talk to somebody, if you don't get help, because you just, and not only do you avoid, you know, having sex with your partner, but you know, I can't leave my house because if I get in the car, and I have an accident in front of my friends, or oh, I can't go out with my girlfriends. It creates just a lot of stress, anxiety, depression, and again, it not only is that something that is going to need help, but it makes your gut symptoms worse. I think too, it's hard to navigate in, like, let's say you're somebody if you're listening, you're someone who's single, and you're thinking I don't even know how to start dating somebody, because that's a big one too, right? Oh, no one's going to accept me, I don't want to talk about it. Well, really great tips are, okay, if you're going on first dates, right, don't involve food, you can do other activities that don't involve food, and make sure you time it during the day, which works best for you. Same thing with sex. Some people are best right in the morning because they haven't eaten anything. Maybe you're really bad because you're somebody that stays up late and you snack and you're really bloated in the morning but then after you've had a bowel movement, like 12 o'clock, you're like ready to go. I think, again, everyone is going to be different and that's going to look different for everyone in terms of what works best for you. But I think just being able to, like speak up as well, for instance, there's no shame if you're in the middle of you know, intimacy with your partner and all of a sudden, you're like, oh, my goodness, I have so much gas, like I have to release it's like, even like mid, you know, mid intercourse, it's okay to be like, hang on one sec, and just run to the bathroom really quick and, and then come back, like your partner is not going to be thinking where are they going? Like, they're not going to dwell so much and as soon as you get back, you're just gonna jump right into it, that's okay. But you can go and release that gas.

Or if you're comfortable with your partner, you can do it there. But there's ways there are so many ways I think that people don't realize to kind of keep doing the things they want to do and love to do and feel. I think it's like our own our negative ego judging ourselves, you know, before we even let others judge us and that like just like you were mentioning, that is the hardest thing for patients to get over. It's just the fear of being judged, called gross the fear of, you know, having an accident. But again, if you have an accident in public, you know, you think everyone's gonna laugh at you, all these things, you know, those people are going to feel just as bad as you are going to feel horrible, but you know, that happened and what are they gonna do? They're gonna help walk you to the bathroom, they're gonna help you out,I just think that that's one of the things that I find with a lot of my patients is you know, maybe eating certain foods that they know they'll be good with or realizing another thing I talked about this with somebody else was if you're on vacation, you know you you want to feel like you're able to enjoy vacation and for a lot of people vacation is eating and food and for people with eating disorders and IBS, gut disorders, that can be even, like vacation is like their worst nightmare. So how do you overcome it? It's going to look different for everybody but with a lot of my patients, I'm like, bring everything, bring your stool softeners, bring your tums, bring your laxatives, you know, your Imodium, maybe you have diarrhea, like bring everything just in case, and then try to enjoy yourself.

I mean, it doesn't mean to eat, like, you know, okay, if you're someone that's gluten intolerant, you know, like, I don't know, one thing I never do is eat gluten. So it's like, you don't necessarily have to, like, eat the things you know, like if you're lactose intolerant, right, you can take a pill and maybe you enjoy ice cream. But you know, you have to find that happy medium, because if you indulge too much, and it just takes wipes you out, you're not going to enjoy yourself. But at the same time, you don't want to be traveling and being like, okay, I brought my, because I'm like this, I bring bars, like you don't just want to be eating bars, or just peanut butter, like, you know, and again, it will look different for everybody. But I think it's okay, like if you're on vacation, you have like gluten free pizza with cheese and you have like a big swollen belly, your partner's still gonna love you. Right?

And also, oh, I forgot to mention this, intimacy, I think this is really big to mention, I talked about this a lot with a patient last week, who was crying about how they have painful penetration and how there's something wrong with her and not them. And I said, you know, everybody has different love languages, you know, you may not be getting aroused, or you may feel you know, dryness or you may have maybe having pain or tightness because you don't really want to engage in that, but you are too afraid to upset your partner. And so like love language can be physical touch, but it can also be acts of service, it can be words of affirmation, it can be quality time. And one other one, I always forget this one, service, quality time…..gifts, I don't like gifts. I'm physical touch and quality time. So again, my partner is acts of service and quality time. So you know, you need to play with that. That's another big thing I think people may miss a lot with with painful penetration and sex is that, you know, maybe you need to know what your partner's love language is so that way you can receive intimacy, maybe you know, you bought them something nice or you you cleaned the house for them or you know, you put the kids to bed. So those are really important because I think that gets overlooked as well. People, women especially, get deemed as having higher low libido all the time and it's like, well, maybe you just didn't do her love language. Maybe she's just not, you know, and then again, you can be aroused and not super wet or lubricated down there, another big misconception. So I think those are big, big things that you know, don't get talked about enough.

Erin Judge: Yeah, absolutely, and that comes down to trust, like we talked about before it all really comes back to trust. And you're right, when you're dating, I think that is harder, because you haven't developed that trust, you're meeting someone new. I'm on the fence of well, like, yeah, you don't want to talk about all the details on the first date, but like, if it's a problem, like you do need to talk about it pretty early, because if they're not going to be supportive, if they're just gonna make a joke, they're gonna laugh, like, if they're gonna avoid you, like, they're not worth more than a date, right? They're not worth your time, male or female, like any gender, it's like anyone that you're bringing into your life, and I see it with friendships as well, like if you're making new friends, and they cannot support you because of issues that you have, or the needs that you have, like, if you need a gluten free restaurant, or whatever it may be. If they can't support that, then they don't really deserve to be in your life and it's honestly not worth it, life is short and like we have enough stress on ourselves. we don’t need other people putting stress on us if we can avoid it.

But it all comes down to trust. And you mentioned a few, kind of warning signs of like, okay, sex, and like your gut issues that people may have, like one would be the leaking, right, and gas or stools, like needing to pass gas, or maybe being stimulated to have a bowel movement, which I see happen often. And we talked about painful penetration and you talked about erectile dysfunction and how that might be connected. And are there any other things that typically show up that you see with like connections to the pelvic floor?

Dr. Kelly Peterson: A few also, like big, big things I noticed is there's a big connection between hormones and pelvic floor dysfunction, right? Even studies linked to how birth control may be a contributing factor to people with IBS. I know there needs to be more studies about it, which I'm super interested about because I had taken birth control for a long time and noticed when I went off with a lot of gut issues, headaches, things got much better for me. So I find there's a huge link with hormones, so if you have like PCOS, endometriosis, adenomyosis, ovarian cysts, fibroids, I mean, there's so many, those type of things can be indicators that you may you're having your you may have pelvic floor dysfunction or another big one is retroverted uterus. So sometimes instead of your uterus being anterior, it's posterior. So when you have penetration, or maybe affects your bowel movements because of that position of the uterus. So those types of things can lead to pelvic floor dysfunction.

I'm trying to think of other things too, that I think get a little bit missed or not talked about as much are people with like acid reflux, like other types of things, that sometimes can be hard, because, like, if you're having sex, and you have a lot of, you know, pressure in your chest, a lot of burning, especially if you're lying on your back, those things can make it a lot worse. So, you know, again, I've talked about this before, there are different positions too for sex, if you are somebody that is having painful penetration, or let's say, if you had reflux, right, you'd want to be more upright, or make sure you don't eat right, two to four hours before. But typically, with painful penetration, some of the best positions are when either the female or the person who's having the pelvic pain is in control. So if it's a female, like if you're on top, right, so girl on top is great, because you can slowly kind of control that, the only thing is, if you're on your knees, your pelvic floor is going to be a little more active, so I personally think that if you, when your pelvic floor activation is at its lowest, which would be either lying on your side, right? Typically talking about lying in left sideline is good for digestion, so some people prefer that, but again, either lying on your side in a spooning position or modified doggy style, where you're just lying on your stomach, your pelvic floor is gonna have way less activation, so those are great.

And then again, people say, also, what is it called Lotus where your partner may be sitting crisscross, and then you're again, in control, you wrap your legs, you can either be sitting on them, maybe you're kneeling, so you can control the depth and all of that. So positioning is important. But I think, again, another big one that they don't talk about a lot is like, so many things I want to talk about, so okay, speed, speed of sex, sometimes people get excited, and they just want to go for it, with people that have painful penetration, pelvic floor dysfunction, like hemorrhoids, or constipation, all that slower is better. And again, one of the best tips I tell my patients is, if you are female, you you grab onto your partner, and you control how they're coming into you, hold him because if you hold like, if you hold in his penis, and you can control that you're controlling the depth, and you also feel more power for like, okay, hang on, stop a second, but going in slower is better. And then again, I always tell people, this when you feel pain, take a deep breath, breathe through a little bit, practicing like diaphragmatic breathing, the goal was breathing down into your pelvic floor and that pain should go away. It should go away, usually for people within seconds to maybe a minute, and then go further. And then again, if they feel pain, stop, and then it's like, so for some of us, yes, is that tedious? Definitely. But you know what, it doesn't matter because that’s something that your partner should be doing for you. Because again, you don't even need to be having intercourse or penetration to have sex, right? You can, there's so many erogenous zones on the body, you can also use toys, again, other love languages. So I think that's a big one.

My patient last week was like, well, my boyfriend said that, you know, all of his guy friends don't have any issues like this and they can just go as hard as they want and they can do it often. And it's like, that's not a very good thing to say to your partner one, because it's not going to help your situation at all. And two, it's going to make your partner feel inadequate, damaged, which they aren't, you know, and I can't stand it when you know, it's very normal to compare yourself to other people even though we all try not to, but I think that's a big thing when it comes to gut health, sex, all of that, you can't compare your journey to anyone else's journey, all of our journeys are going to be different and our needs will be different.

So those are some tips in terms of you know, if you are and then again, like using devices like I talk a lot about this on my social media, pelvic wands for trigger point release, basically imagine like give tight upper trap in your neck, like you press down and t feels good to hold it there. You can do that internally with wands, vaginally or rectally, and then dilators for people that maybe have a hypertonic pelvic floor or vaginismus. And again, the quick difference between that because that gets confused a lot, if you're somebody that just has a tight pelvic floor that just means you're tight down there. Maybe because of exercise activity, that's where you hold tension when you get stressed. Vaginismus is involuntary, you're like doing everything you can do let it relax, but you are clinching and it's something you can't control. So that's a big difference and those get treated a little bit differently.

And then there's ohnuts, I don't know if you know about those, the stackable discs. So you can imagine like, imagine just like a cylindrical kind of like dilator or you can just imagine your partner's penis and then there's like these stackable silicone circles, and they're like, a half an inch, or maybe like a couple centimeters thick, and you can maybe have, maybe you have so much pain, you can only handle just an inch of your partner in you. So you have all five, you know, stackables. And then as you get better, you take them off. So what's nice about that is your partner can then thrust a little bit more, but there's a blockade there so you have less pressure, which is great for those people that have pain with a deep penetration, because some people, right, there's a difference between, like having painful penetration deeper, versus like some people just have external pain like vulvodynia, vestibulodynia and that's just around the opening along the lips at the perineum, so they're different. So, yeah, there's so many great tools. But again, I just think people don't have the resources for them just not talked about.

Erin Judge: Absolutely not. I mean, you're talking about a lot of different potential solutions that would only come from talking, right, it's only talking about specific issues that you're having, talking to your partner to, like be able to, you know, have them help you because that's something big that you may not know, you know, where the pain is coming from, or like how to adjust or any of that if you're not communicating. And if you're being told that, well, it's you, you're the problem and this is abnormal, and you're just being too uptight, or whatever it may be, if you're being told that there's something wrong with you, then you're obviously not going to talk about it because you may not even know oh, actually, there is something that actually can be done, that needs help and support. I say that even IBS, like people are diagnosed with IBS, but somehow still not told that, hey, there are solutions for you. Like you don't have to have diarrhea every day, you don't have extremely constipated every single day, like there are true solutions. And so people just feel like, oh, my body's broken and I guess like I'm just being too uptight about it versus like, no, there's something wrong that we can address.

What does it look like to get an evaluation? So you talked about a lot of different potential solutions and you mentioned a few times that it's so personalized, like the care that you provide, and even the solutions that people find on their own, so what does that look like for an evaluation? Like someone says, okay, I have issues like with this, like, this is something that I'm concerned about, I want to go see maybe pelvic floor PT, what does that process look like? Especially when assessing what is going wrong with sex?

Dr. Kelly Peterson: Yeah, this is something I get asked all the time. I love talking about it because I think people have so much fear just even going in. Every time I get a patient that comes in, almost all of them, their shoulders are like up toward their ears and I totally get it because you know, they're sitting down, they're looking at the posters on the wall, then, you know, here's me with like my pelvic model and like smiling, like, hello, tell me what's going on?

So basically, what it looks like is I'm just going to get a subjective history from you. I want to know what's going on? When did it start? What other treatments that you may have had, other specialists you may have seen or imaging tests done, go over any other medical history and a big one medications. I know medications are great for treating issues, but sometimes you have medication interactions, or I’ll notice people are on medications that may actually be making their symptoms worse, like constipation, diarrhea, which I'm sure you see all the time going through that. And then once I kind of go through, you know, okay, so what are your complaints? What are your goals? That's the biggest thing. I think, a lot of times people go to their doctor, and because the way healthcare is going right now, it's so quick. It's 10 minutes, and you write down all your questions, but you can't even get them all out and you feel so rushed. My whole thing is, what are you here for? I want to know what you're experiencing, and what do you want out of this? And then from there, right, say, oh, I have constant pain, I have interment and gas, I have shortness of breath, whatever that is, when is it, with what functional activities, because ultimately, as a physical therapist, yes, it's important to get your pain to go away and get rid of that. But more importantly, I want you to return to your functional activities and improve your quality of life. Like that's the main goal. So if I want to get back to biking or hiking or sex with my partner, all of those things, and once we talk about that, then I go to my objective exam, that's when I'm going to, you know, I'm going to check and one of the big things people don't realize is you don't have to have an internal exam during your first appointment or ever if you don't want to.

I had a male pelvic floor patient evaluation last week, and they were really nice and they were like kind of unsure whether they wanted it but they said, okay, for the first visit, I want you to do an assessment. And then after that, you know, I was able to figure out what was going on, but they were like, okay, I want you to do all treatments external. And I was like, great, I can totally do that. So it's really up to you, your comfort level, because I again, I know a lot of people have experienced trauma and that doesn't have to be in that traditional sense. It can also just be mental abuse, you know, a lot of different things. So what I'll do is I'll check your breathing is the first and most important, if you can't breathe properly, that's something I focus on the whole treatment almost, then your posture, I want to look at your flexibility, like your joint flexibility, soft tissue flexibility, and it's head to toe, right, it's not just, you know, your pelvic floor, I want to see, can you touch your toes, are your hamstrings tight, a lot of muscles that surround the hip, you know, that support the pelvic floor can be related to your spine, right, your jaw, your neck, because again, there's a huge jaw pelvic floor connection because of the spinal cord.

And then from there, the most important is doing my internal, external and internal exam. So what it looks like is, most people get undressed from the waist down and I have a pelvic model and posters and I walk through, okay, this is where I'm going to push on and palpate I'm trying to reproduce the symptoms that you have to figure out what's causing it, or to see what's going on. And I'll look, you know, we check, okay, do you have any hemorrhoids? Are they active? Do you have skin tags? And you know, what's the color of usually it looks great. And again, a bigger thing, too, is a lot of people get really nervous with like, I didn't shave, or I'm on my period. And again, those things never matter to us. I'll go, I'm on my period too, so they don't matter. And if you're uncomfortable, then again, I can wait till next week to do my internal exam.

So we'll go through and we'll try to see what's going on and then once we kind of do the external, we go in, usually for females vaginally, and I'll just be again, pressing on different structures of the pelvic floor, checking to see where you may have pain, tightness, anything abnormal, right, some people get developed cysts. And then from there, can you Kegel, or can you contract your pelvic floor muscles? And you know, again, the quality of that, how strong is it? Can you do it quickly? Can you hold? Yeah, and then again, for people that have constipation, sometimes I will, or let's say you fell and broke your tailbone, you're having coccyx pain, tailbone pain, I might want to go in rectally as well. And I may do it on the same visit, I may not. And again, it's similar and palpating different structures, trying to see what's going on.

And then again, because of my visceral background, I will check your stomach as well. Like I like to check your belly see how your fascia connective tissue is moving, all of that and and then if you have like abdominal surgeries or scars, that's something that I think I talk a lot about that and that's something that I think is completely mistreated in a lot of patients, breathing and scar tissue. Because if you have limitations and soft tissue in your abdomen, it can definitely not only affect digestion, but also your pelvic floor, and I find that a lot with especially postpartum pregnant women.

Erin Judge: That's helpful. I think it's helpful to know expectations, right? Where it's like, you know, there's a lot of misconceptions. And because we don't talk about things enough, we also don't talk about what the solutions look like. I think a lot of times, it's like, well, oh, like, something's wrong, I guess I just need to wait or like, figure it out, or even you know, those who have delivered a human being, it's like, you still don't get told, like, oh, no, this is what recovery should actually look like, or like, this is what you should notice, these are things that you should actually do to like help. And I think that that goes back to obviously, how, like women are treated in the healthcare system. But even I think with erectile dysfunction, like, I don't know about you, but all I see are medications, right? It's like I see medications push, I think they're pushed more than what's available for women. But you know, we don't talk about like physical therapy being an option. I work with males who have issues and they have pelvic floor issues, and they don't believe that that can be available for them, getting physical therapy for that. And so, it's good knowing okay, this is an actual option, there are professionals that you can talk to about these things that are going to be able to actually evaluate them and not just make assumptions or not listen to you. And that's where the pelvic floor PT part comes in.

So let's talk about the erectile dysfunction piece, I know that we have just a couple minutes left, but I don't want to leave that part out. So I think you know, we've talked about like, people penetration and that side of it, but I think erectile dysfunction and even then with IBS, they message me all the time, they get left out and I get it, we don't want to leave them out. What does pelvic PT look like for male anatomy versus female anatomy?

Dr. Kelly Peterson: Yeah, so typically somebody that has erectile dysfunction, they're also seeing another specialist. And again, they may be getting injections or going through medications, taking different things to help with that, but then they're coming to us to, let's say, find out if they've had nerve damage. A lot of times people don't realize this, but like 50% of men over the age of 65 will develop prostate cancer. And like the statistic, it's something crazy, like 98% of men that get a prostatectomy, get their prostate removed, have like fecal and urinary incontinence. And so just think about that for a second, how many people above the age of 65 are probably walking around with adult diapers, right, which is really sad, especially like males, you know, don't want to be seen as vulnerable or weak, and so there's that whole component to it as well.

People don't realize that your pelvic floor muscles, which helped to you know, obviously, there's a nervous system component, but if you've had surgery down there, or you've had back surgery that's affected your pelvic floor, because a lot of people don't realize, when you get back surgery, if you know, they hit a specific nerve, it can cause things like, incontinence, ED, and so we're looking for, okay, you know, how can we help them, right, is there scar tissue restrictions? Is this something nerve related? Maybe they need to work on breathing to help increase circulation, which helps with healing. Peyronie's Disease, another one that I see which is like, idiopathic as well, meaning unknown, kind of how people get it, but it's like scar tissue, and people's penises will start to bend or contracture to one way, and that can be excruciating, because when you have an erection, your penis wants to go straight. And so that's one that I see is, you know, really hard, not only physically but mentally for males, but we work on breaking up scar tissue for that.

It depends on every therapist, how they treat, but typically for all of my males, I like to do an internal exam as long as the patient is okay. And sometimes, you know, the issue maybe isn't necessarily like in the rectum or at the external anal sphincter, right, where your poop comes out, maybe it's in the spine, maybe their sacrum is stiff, and they don't have enough joint movement, right, because nerves come out of it. So it's complex, but again, I think it would be less complex if there were more studies and if more people just came in for treatment. I think people like you probably see this too, people leave things for a long time, because either they don't have the resources or the funds to go seek help, or another one is people don't even know where to start. They don't even know that specialists like you or I exist. And then again, there's just like fear of embarrassment, like telling their friends. But again, I talked about this before, I talk to a lot of my girlfriends, and you would be surprised how many friends that I know that have pain with penetration or pelvic floor dysfunction and they still won't see me because they just, I totally get it, you know, they want to just handle it on their own or they’re unsure and so, big component.

Erin Judge: Yeah, yeah, absolutely. And it comes down to communication, which is what you said at the start. So I think the big takeaway is like, communicate, like check in with your body don't ignore even things that may seem small. And if someone makes you feel bad about it, cut them out first and move on to do your own thing. Or to stand up for yourself and get support with that if you want to keep that relationship. Really talk about it, communicate, push for referrals, and if you don't get them, seek others. If someone is listening and they're interested in working with you, we'll make sure to link everything that we can, but is there a best way or how do you prefer people get a hold of you?

Dr. Kelly Peterson: You can message me on Instagram. You can also just link in my bio, my Linktree is linked to my Instagram bio as well as my TikTok and my Facebook, so if you go there, I have links to my online program, The Belly Whisperer Method. It's just like the five step program. The reason I created it was because there was just so many people that I could treat hands on, and I could reach just because I'm only one person and what's nice is it's the exact same model or methodology that I use when I treat people in the clinic like breathing, posture, flexibility, strength, and then belly buddy meaning like support. It's the same hierarchy that I use, it's now just all on an online program, which is great because it's self paced, so you can do it on your own time and there's just so much so many good things. It's hard because people message me all the time and all I just want to tell them if you watch these videos, your problems will be so much better. But again, I realized that finances are tough right now, there's those types of factors as well. But I also have in my link tree webinars, and there'll be specific like, again, the painful penetration and sex, I have a breathing webinar, a posture webinar. And then also in my link tree, you can make an online appointment, if you're somebody that's, you know, not local, or if you are, you can make online appointments, I offer 30 minute and 60 minute appointments. If you're local, I'm in Irvine, California. And it's nice, I'm working out of an office now, so you can book an appointment there and evaluation and follow ups.

I have some new projects that I'm working on, I'm kind of excited, so those will be coming soon. But yeah, lots of different things. I have lots of resource and free videos. That's what's nice, too. I have free videos on how to use dilators, and wands, so that way, people can have just more access to different types of tools for pelvic penetration and pain in pregnancy and postpartum care. So yeah, tons of different ways to reach me!

Erin Judge: So much! And I highly encourage you, even if you're not someone who thinks like that this is a concern that you have, or you're not really sure that you need actual guidance, definitely check out Kelly's social media, I've learned a lot just about my own body. I think that's really helpful. You can learn about yourself, but you also might need some tools that you can use to support a friend, support a partner, you know, and have things to talk about to see if your partner needs support, because might help even ask those questions ahead of time with people.

Thank you so much, Kelly, this has been so helpful, I really appreciate you coming on!

Dr. Kelly Peterson: Thanks for having me, I love talking about this! And again, it's super important and not talked about enough. I don't know why, I mean, I do and I don't, but anytime you want to talk about sex, and pooping, all of that, I'm here for it! Or IBS, we can just talk about our IBS journeys. I'm sure your journey is, you know, pretty remarkable as well, right?

Erin Judge: I think so. I think when you live it so long, it's like, it doesn't seem like it's a big deal anymore, but you know, it's more of looking back and feeling really sad for the little girl that was dealing with issues that never got support. And now getting to be the support for so many people is such a big thing. But it's also ongoing, you know, it's not like the Cinderella story where it's like, oh, yeah, you know, everything just disappeared. It's like, no different stages of my life, like things change and so I'm in a constant state of learning my body, like supporting my body, working with my body and that's the trick for me and that's what's worked and the value I've gained in other ways out of that has been so good, where now I say, I'm thankful that I had my IBS and thankful for that history that I had because now I'm more connected to myself than I've ever been and I think that's such a big powerful thing to know your body and know what your body's saying, even if it may not be perfect, but just knowing like, okay, like, this is what we're working with, like continuing to progress and grow.

Dr. Kelly Peterson: It's so true. Like, I tell a lot of my patients our bodies are like cars, like we need constant maintenance, and you're right, like with IBS, or with any type of chronic illness or issue, people just want that quick fix. The hard truth is that you're just constantly going to have to, you know, work at it. But you know, it becomes like you said, you get so good at knowing how to help yourself, but again, it's not like, you know, the IBS doesn't define you, it's just something that you have. So I think that's huge for people.

Erin Judge: Absolutely. And I think that's the value of investing the time and even the finances, where you have been into getting support is that those tools are not meant to be, oh, here's the stretch you do, and then you're at, it's like, consistently encouraging people to keep doing the work, like you can't just do it once and then it's done or you can't eat, you know, fiber for a day, your gut microbiome is happy for 10 years, like, it just doesn’t work that way. And so investing that time and like the energy and it's not always easy, sometimes it's trial and error. Sometimes it's uncomfortable, sometimes, like you mentioned, it takes a lot of work to get to where you want to be, but once you get there, the return is so strong and having that confidence and that is worth it. Because like you mentioned at the very beginning, we don't want to give up quality of life, you deserve to live a full life. And you may have some barriers you have to work through to get there, but you know, you still deserve to have a full life, you don't have to wait 40 years of dealing with things through your entire prime of your life completely suffering in silence or losing that because we're not going to get it back. So I'm passionate about that too! It's like we have to, you know, invest the energy and do what we need to and that might look like spending more energy to get your insurance coverage to go to someone or it might look like hiring someone out of pocket, like it doesn't always have to look one way, but figuring out the solution, getting the guidance is so important!

Dr. Kelly Peterson: That brought up a good point, because I think there's so much misinformation or because of the way social media is nowadays, you look at people, and you hear people's stories, or maybe someone's promoting the end all be all product, right? Like the one size fits all, which I don't agree with, and people just they hang on to that hope of like, oh, if I just take this, I'm going to be just like her. But in reality, you know, and I know that that person may be also doing 10 other interventions that you don't see, or, you know, you have no idea that the truth behind a lot of that. And I think that's so hard for people, because so many of us rely on what we read and see on social media, that it's just like false hope. I tell people false hope, like, what do you think about if I just try this? Or if I just take this pill? I'm like, oh, it's so much more than that.

Erin Judge: Absolutely. Our patients like they're referred to a therapist or referred to a pelvic floor PT or you know, referred to a gastroenterologist, we're working with the PCP, sometimes an endocrinologist, gynecologists, we're working with so many different providers, and even in our group programs, like we have a whole lesson on pelvic floor, we have these things, it's like, we have to have those referrals. And that is, I think, daunting and overwhelming. And when you're thinking about managing all of those people, getting them to work together, like it is overwhelming. I would be lying if I said, oh, it's so easy to put your healthcare team together.

Even working together with other professionals, sometimes that's hard, because we're all doing different things and sometimes, you know, my patients need to go get the pelvic floor piece worked on before we can work on more, because if they can't release the poop, like it, we can't do that much, right, it's like, we're not going to help much, we're not going to see the results we want. Or if they're on a medication that has a side effect, until we taper off of that, you know, we're not going to do this, maybe some people do need a medication that, you know, that's going to be the solution to help them motility. But we can't do it, you know, or they had surgery and then we have to deal with the scar tissue. It's like there's so many layers. And that's why, you know, it's not easy, but that's why communication to your doctor is also really important, pushing for referrals, learning about your body and when you see these things come up, like put those people together, and then make sure that they are actually working together.

I think something that people also need to do a good job of if like, you know, other professionals may have different opinions and that's great connect to them, because you never know, like what people can do when they coordinate or where steps may fall into line. And it might look one way today and then it may look completely different in three months based on your progress and where you're at or what we've learned. So yeah, it's not always straightforward. It's not simple. It's rarely ever a quick fix, unless you just happen to stumble upon that one missing piece, which does happen every now and then for people, but rarely. And then also know that if you have had problems for a long time, and you have kind of just ignored it, or maybe things have gotten worse because of disordered eating or because of more trauma or because of, maybe you had pain so you don't move your body at all and now there's issues there or there are hemorrhoids and fissures and all these other complications, like it's going to take time. And so it's not going to happen fast, which is okay. That's where making sure that you're working with people that are going to help encourage you and celebrate with you can be helpful.

Dr. Kelly Peterson: Yeah, 100%, It it can be it can be such a long journey and I think like you said, advocating for yourself is really hard because I think people don't realize they have autonomy when it comes to health care, meaning you don't have to take anything or you don't have to do anything you don't want to do. If your doctor says you have to take this medication, but you're unsure, you're kind of scared that you need this surgery, go talk to three other doctors. Yes, is it going to cost you because maybe you have to do three more copays. Yeah, but is it worth not you know, having this invasive surgery?

I just had a patient recently who was diagnosed with MS, multiple sclerosis and they wanted to have her do this $10,000 program, this surgery, all this stuff. Then she went to like the top Ms. Specialist at UCI, and they did like an MRI of her brain, CAT scan. And they told her she did not have MS. You trust your doctor because you want to believe that everybody, especially doctors, have your best interests at heart and unfortunately, the world just doesn't work like that and it's unfair in that way and it's really sad to hear, but remember, like, just trust your gut instinct. If you don't like your doctor or you don't feel like your doctors listening to you or you're scared, talk to another doctor. Like, again, just like you said, we all have our different specialties, we all have our different viewpoints. You don't want to give up hope because there's so many people out there researching or going through what you're going through, trying to find the cure or trying to find the best thing. So there's always going to be new things coming out, which is exciting. Like that's, you know how healthcare grows and all of that, but that's really important to remember.

Erin Judge: Yeah, absolutely. Great point! Well, thank you, Kelly. I don't want to use up too much more of your time. I so appreciate the conversation, and remember, if anyone wants to connect with Kelly, show notes, have everything that you need, you can also reach out to her on social media if you have any specific questions that she might be able to help you with.

Dr. Kelly Peterson: Thank you so much for having me. Your listeners can go to my website and use code GUTSHOW15 for 15% off The Belly Whisperer® Method Online Program.

Erin Judge: Okay, awesome. Sounds good!