Chronic pelvic pain (CPP), which includes interstitial cystitis, urinary tract infections, myofascial pain, pelvic floor pain, dyspareunia is a common, underappreciated problem in women. Indeed, one study looking at primary care practices found pelvic pain an issue in almost 40% of all reproductive-aged women. CPP is also identified in men, most commonly caused by prostadynia or prostatitis. What can we do as functional medicine clinicians to assist this population?
Turns out, quite a bit.
Listen to this very interesting and inspiring conversation I had with Jessica Drummond, MPT, CCN, CHC, founder and CEO of the Integrative Pelvic Health Institute. Jessica has made it her mission to train clinicians and treat women using a functional approach to chronic pelvic pain. As a physical therapist who later trained in nutrition (and is currently working on her PhD), Jessica discusses how to identify and address the multifactorial influences on CPP including: diet, gut/microbiome health, musculoskeletal conditions, hormone imbalances, nutrient deficiencies, stealth infections, mind/body and detoxification.
Dr. Kara Fitzgerald: Hi, everybody! This is Dr. Kara Fitzgerald. I am so happy to be with Jessica Drummond today. Jessica is a physical therapist. She’s a certified clinical nutritionist and a certified health coach. She’s been a physical therapist for more than 10 years now and she’s specialized her practice towards women’s pelvic physical therapy and she’s really turned her attention towards women’s health in general.
She’s the founder and CEO of Integrative Pelvic Health Institute and she’s just very dedicated to empowering women who struggle with chronic pelvic pain.
Jessica, before we jump into grilling you, I just want to say (because I know that you’re going to give us a lot of pearls today), I was looking in the literature a little bit around chronic pelvic pain as a condition. I’m a functional medicine generalist and I do have some women in my practice with chronic pelvic pain and it is challenging. It can be very challenging to address. But really, it’s an extremely underappreciated issue.
So in the literature just today, I was looking at the cost, the estimated direct medical cost for it. It’s nearing $9 million a year – excuse me, $900 million a year. And in one study in particular, they said that in the primary care setting, almost 40% of women were reporting pelvic pain. So it’s such a huge and underappreciated issue.
Jessica Drummond: Yes, absolutely.
Dr. Kara Fitzgerald: Tell me a little bit about your journey towards addressing pelvic pain and some of the other ways that you’re supporting women’s health in general.
Jessica Drummond: I think it’s very interesting that you say that. Such a large number of women are struggling with pelvic pain. And so I’ve been working with women with pelvic pain professionally since – well, I graduated from physical therapy school in 1999. And I pretty quickly, a year or two later, started specializing in women’s health and pelvic health for women – and also for men, although my practice has always been mostly women. I worked in a women’s hospital and now, I focus entirely on women. But there are quite a few men with pelvic health who, I think, are even more underappreciated where the pelvic is concerned for their pain, who are even more underappreciated. So that’s important.
Essentially, I started working with pregnant women, with women with breast cancer, recovery issues. What I found as a physical therapist was that pelvic pain was one of the really challenging clinical issues because it can involve the skeletal issues, it can involve digestive health issues, it can involve neurologic issues, dental nerve pain, it can involve bladder and reproductive organs. So there’s a lot going on that is really housed in the pelvis.
So clinically, it was very challenging.
And then about, I think it was around 2008, 2009, I was personally diagnosed with adrenal fatigue a few years after I had my first daughter. And I was really sick. If you’ve had seen with that pretty significant flatliner adrenal fatigue, you’re completely out of whack and so fatigued. And it’s one those things that’s very mysterious to most clinicians especially then because no one was really talking about it.
What I realized is that nutrition was a very key piece of my recovery personally. And I thought if nutrition can have such a significant impact on hormones, I felt as a physical therapist – and I really think physical therapists are the ones who are the most knowledgeable about pelvic pain, your gynecologist as well.
But in terms of clinicians, a lot of people don’t realize that physical therapists are really a good place to start. Those that specialize in pelvic health have a lot of specific training and there are a lot of issues that can be resolved just with dealing with the pelvic floor musculature. But I realized as a pelvic floor physical therapist that nutrition was a big missing piece in addressing these concerns because of all those different systems.
We talked briefly about fiber for constipation, but nothing about gut dysbiosis, nothing about adrenal hormones and sex hormones and some of the natural opportunities for balancing those.
And because this issue really impacts women throughout their lifespan, I started to apply it to women who are post-partum, who had more birth injuries or women who were menopausal or were perimenopausal and having low estrogen issues. And bladder, more and more bladder pain are stemming from things such as interstitial cystitis.
In this functional medicine perspective, it’s like we have leaky gut. We also have leaky bladder. It’s an issue of an autoimmune condition that stems from a lot of different things.
Anyway, the point is that I became a physical therapist and then became a nutritionist because I felt like there was such a missing piece, and then a coach because there’s such an emotional charge to this area.
Dr. Kara Fitzgerald: Got it! So you just dropped so much powerful information. I’m trying to jump in here because I want to go through this. I’m sure other clinicians and people listening to this will (particularly people who are suffering from pelvic pain or the clinicians working with them) feel empowered and heartened by the fact that you’ve applied this functional approach. And I know that you’re getting wonderful outcome.
So basically, you’re looking at whole person medicine. You’re really using your skills as a physical therapist and now your training as a nutritionist in chronic pelvic pain in general regardless of etiology. So you’re seeing beneficial outcome with this functional approach in general. Is that what you’re saying?
Jessica Drummond: Yes. And I don’t do any of the hands-on pelvic floor physical therapy anymore. I haven’t done that for a few years, but I do collaborate quite a bit with my colleagues who do the hands-on pelvic floor rehab. And then I fill in the functional medicine, functional nutrition pieces of the puzzle.
Dr. Kara Fitzgerald: Okay. And that’s what the Integrative Pelvic Health Institute is. People could actually access you or refer to you. Go ahead.
Jessica Drummond: Yes, so the Integrative Pelvic Health Institute is I have a small practice of clients, patients, and also, we do a lot of training of gynecologists, of pelvic floor physical therapists, of functional nutritionists who want to specialize in different women’s health concerns. We do a lot of education.
Dr. Kara Fitzgerald: That’s wonderful. I know I’m diverting and we’ll circle back to the topic in a second, but are you doing this as online training, or one-on-one coaching or do you actually offer seminars, in-person seminars? How do you do that?
Jessica Drummond: Both. It’s primarily a nine-month online certification that you can do through online education. And so we have students, various kinds of women’s health and wellness professionals in, I think, 10 or 15 countries now across the globe. So that’s really exciting.
But also, sometimes I speak at conferences or I’ll do an in-person seminar if a clinic requests for me to come and do pieces of that training in person. I do that from time to time as well.
Dr. Kara Fitzgerald: And you take patient referrals as well?
Jessica Drummond: I do, yes.
Dr. Kara Fitzgerald: Great. Thanks, Jessica.
So let’s zero in on interstitial cystitis. We all work with women and actually, there are certainly some men with interstitial cystitis although as you pointed out, it’s much less recognized, and apply your approach to it. So let’s talk about some of the causes of IC that might be overlooked in a traditional setting and walk us through how you would approach working with the interstitial cystitis patient.
Jessica Drummond: So interestingly, in the literature, there are some relatively recent published case studies looking at how interstitial cystitis is intertwined with small intestinal bacterial overgrowth, for example, gluten sensitivity, and I also see in my practice other common food sensitivities, and even Lyme disease.
My perspective is such that when we’re thinking about the bladder, it’s more often a symptom, a clinical manifestation of essentially an autoimmune response or a heightened immune response to gut dysbiosis or potentially something more like Lyme, parasite or a bacterial infection or a food sensitivity.
And there are some interesting studies detailing what’s called the IC diet. And that takes away foods that on survey data, people that have IC report it being irritating to them. And there are some common ones, things that are more acidic, sometimes nightshade vegetables or certain acidic food, diet sodas, things like that that in functional nutrition, we would get rid of anyway, alcohol.
And so what I do is take that general idea a bit further and try to figure out why in any individual case something is irritating a person’s bladder so much.
Usually, it’s a couple of different things. So we look at the digestion, do food sensitivity, elimination kinds of diet. They can be tested for SIBO, they can be doing something like stool testing.
I refer it to a lot of functional medicine physicians, things like stool testing to see if we can improve the gut health, which is, of course, the foundation of improving immune system health. And then, also collaborating with pelvic floor physical therapists because if you have that bladder pain for some time, there can be some muscle spasm, some tightness in the pelvic floor as a response to that pain.
So if you can imagine if you had chronic pain in your shoulder, the muscles in your neck, in your upper back and in your arm would be tight just from guarding against that pain for so long. So pelvic floor muscle rehab is important.
And then additionally, you want to come out it with a coaching angle because again, the research on pain is now pulling together into what we call the biopsychosocial model of pain. So pain is more of a signal, a general signal that’s something awry or something was awry at some point and less so much indicative of acute tissue damage especially when the pain becomes chronic in something like these bladder pain issues, which can sometimes stem from things like chronic UTI or chronic bacterial infections or sometimes it seems like that and they’re treated over and over for with antibiotics, for bacterial vaginosis or antifungals. But underlying, they couldn’t really ever find an infection. Do you see that?
Dr. Kara Fitzgerald: Absolutely.
Jessica Drummond: And so the brain’s interpretation of pain becomes heightened. And so a lot of my clients with any kind of pelvic pain, but certainly bladder issues, it’s all tied in with how often they have to go to the bathroom. And there’s a lot of fear about, “Is there going to be a bathroom around when I need it?” And there’s a lot of frequency and it’s waking these poor women up at night multiple, multiple times.
So getting to the mindfulness training to help downregulate a little bit that heightened pain response because it’s like, ”Okay, now we understand there’s something going on the bladder. We’re going to try to get to the physical root cause. We’re going to calm down the muscles and nerves around it. But also, we’re going to try to quiet the brain from responding so much, to let it quiet down.” that helps with the frequency, that helps with the intensity of the pain. And so it’s a multi mind/body approach.
Dr. Kara Fitzgerald: It’s very powerful. And it’s really truly a functional or a systems approach that I hear you’re talking about. So in an IC patient or somebody with even chronic bladder infections where there is no organism identified, you’re doing a handful of things here.
First of all, you do recognize an immune system imbalance be it dysbiosis, be it lower dysbiosis or SIBO, and then damage to the mucosa, food sensitivities, et cetera. So you’re focusing on the gut. There may be a wider investigation for some kind of stealth infection. You mentioned Lyme. And then you also talked about bringing in the physical therapy component.
So there’s going to be various imbalances that occur just given the duration of the pelvic issues. So PT is essential.
And then you brought in mind/body. I really appreciate that, Jessica. And I wanted to ask you, again from a functional approach, you must be thinking about nutrient status in these individuals with chronic pelvic pain. And what are some of the major nutrients that jump out at you that you seem to find deficient or insufficient in this population?
Jessica Drummond: Well, certainly if they have an issue of gut dysbiosis for a period of time, either chronic antibiotics or just SIBO, any of these things, it’s difficult for nutrient absorption. So certainly, the B vitamins, folates, B12, B6, also magnesium, which when the magnesium is low, sometimes that pelvic floor tightness can be worse; all the antioxidants because you can have an issue of essentially too much oxidative stress just from the immune system being so overactive for some time.
As you said, women come to general health practices, 40% of them with pelvic pain. But for many of them, they don’t really find the right clinician or the right approach for up to 7 to 15 years. So they can have antioxidant depletion. They can have, certainly, micro mineral depletion. They can have B vitamins for sure or so. It can be quite extensive in nutrient deficiencies.
Dr. Kara Fitzgerald: Yes, absolutely, particularly over that period of time. It makes me think of the length of time it takes somebody to be diagnosed with celiac.
Circling back to the immune component, vaginal dysbiosis, it’s an issue in these women. Do you address it directly or do you address it through manipulating the gut microbiome?
Jessica Drummond: Yes, I tend to start with a gut microbiome. From a very practical approach, a lot of gut healing – taking off any food sensitivities, adding things like bone broth, adding probiotic food. Probiotic supplements are so tricky because it’s so hard to know any individual case which specific supplement is optimal. There is so much research still to be done there that in most cases, I start with probiotic foods, not necessarily dairy foods. It might be more like coconut, yogurt or sauerkraut or kimchi.
But I do use probiotic supplements as well and it’s more of a trial and error approach really.
Dr. Kara Fitzgerald: Absolutely! That’s what I assign in my practice as well.
So let’s talk about another issue moving away from interstitial cystitis to painful sex. Again, just huge, also I think underappreciated, but perhaps a little bit more recognized. Can you talk about how you would specifically approach that issue in women?
Jessica Drummond: Yes, painful sex, first of all, there are certain times in the lifespan where it’s more common. So either women who have never had a sexual experience and then they get married, they may be in a more traditional population, they might have vaginismus and there can be physical issues for that, just the pelvic floor muscles can be very tight. that’s quite amenable with a really skilled pelvic floor physical therapist, someone who also does maybe some energy work to just do a lot of relaxation and a lot of down training.
And then post-partum is a common time. And also, coaching is good in vaginismus because certainly, unfortunately, sexual trauma, sexual abuse is very common. Just difficult sexual belief about sexuality really needs to be addressed for women to be able to transition to having healthy sexual relationships.
So I use a lot of coaching skills there and I also collaborate with psychotherapists who have got long experience with sexual assaults. I mean, the numbers are huge. One in four or five women have experienced some kind of sexual abuse or assault. And so it’s a very common issue.
And then also physically, post-partum. Certainly, labor and delivery is not always kind to the pelvic floor. So we address healing the soft tissue, scar mobilization. A lot of times a woman will have an episiotomy or something of that nature, or tear. And it gets stitched up. And then they go to their six-week appointment and they’re like, “Okay, everything’s healed and you’re fine. Go home and have sex.” And if it’s not comfortable, the only response they get is relax, have a glass of wine. There’s so much more that can be done.
Scar mobilization, just education about the fact that, “Okay, while you’re breastfeeding, your estrogen levels are going to be so much lower. So it’s normal to have a lot of vaginal dryness. You might want to consider different lubricants, different positions. You’re tired. You’ve got a new baby. You’ve got to really adjust to the expectations.”
Again, that’s where coaching skills come in quite handy.
And perimenopause, you’ve got the same thing. You’ve got this natural change where estrogen levels are changing. And many women in our society also are estrogen-dominant because there’s so much exposure to estrogen toxicity in the water, in plastic, in a lot of our skin care. Progesterone levels can be low.
So it’s a combination between really naturally balancing the hormones, addressing the musculoskeletal component so that if the muscles are tight or weak or the woman just don’t really know how to relax them or they’re just fatigued and they need a lot more foreplay, they need to have – when life changes so much, sometimes you have to adjust that also in your sexual relations.
So there’s a combination again of mind, body and physical factors in every case.
Dr. Kara Fitzgerald: Yes, absolutely. And I have two questions – well, I have one comment and half a question. I just wanted to circle back again to interstitial cystitis or chronic UTI patients. You’re also, I’m assuming (correct me if I’m wrong), seeing the same estrogen-dominance in these individuals, possibly adrenal fatigue, as you mentioned initially, as well as overexposure to xenoestrogens. This hormone balancing component seems to be an essential aspect to a good functional approach to pelvic floor pain. Would you agree?
Jessica Drummond: Yes, totally! I think with any cause of pelvic pain – because a lot of times, you can’t tease out just one thing. Women who have pelvic pain could be struggling with constipation in combination with interstitial cystitis, in combination with pelvic floor like vulva vaginal and pelvic flood musculature involvement.
So it’s not actually very often that you can really isolate it to only one specific thing. So the hormonal component certainly comes into play.
Dr. Kara Fitzgerald: And that would be why the IC diet is inadequate. I mean, I would say in my experience using the IC diet, it takes individuals a few steps along the journey. It opens their eyes to some foods that irritate. But in my experience, there’s always been more. Additional investigation is needed. We have to cast [inaudible 00:23:26]. You see that as well.
Jessica Drummond: Absolutely. I agree with you. I think the IC diet is a very basic – okay, certain things are going to commonly irritate the bladder especially if it’s already vulnerable, but yes, when you’re not at all dealing with gut dysbiosis, you’re not at all dealing with food sensitivities or you’re not dealing at all with liver support for estrogen detox, even women who have low estrogen often have estrogen dominance. You’ve got to deal with both of these things, you’ve got to really support the liver, you’ve got to support progesterone levels because they’re often so low.
There are testosterone receptors in the pelvic floor muscles. The musculature themselves can be weakened.
Dr. Kara Fitzgerald: That’s great. You brought up testosterone. It flags me to ask you, how might you address pelvic floor issues differently in men. I know you’re taking this full functional systems approach to them, so there’s a lot of overlap and I know you don’t primarily work with men, but can you talk about the male pelvic floor patient?
Jessica Drummond: Sure. I really haven’t worked with men in probably at least six or seven years now, but I have enough experience that I think I can apply this.
So first of all, there are some differences. We do pelvic floor myofascial release through the rectum in men. So you can address those muscles. Men often come with things like chronic prostatitis, which again, is super general. What is causing that inflammation?
You want to get to the root of it. It’s something digestive in many cases. It could be chronic inflammation, a metabolic syndrome, especially if they’ve got erectile dysfunction in addition to that.
So you’re always trying to figure it out because in a sense, it’s a symptom, a result, not a root cause. And so getting to the root case in men is very similar with women in terms of the immune involvement, in terms of the digestive involvement, in terms of bladder, bladder training so that you’re not going too frequently, education, sex hormone balance.
But things like chronic prostatitis or the diagnosis, or men who have had prostate surgery, a lot of times, post-surgically, these men will come in for pelvic floor rehab and they have problems with erections, they have problems with sexual function, they also may have pain. So you can address them as a post-surgical pain patient, so dealing with all the recovery of surgery. Again, the liver comes into play there because they’ve been on medications and anesthesia. And you want to be sure they’re detoxing adequately.
So there are a lot of similarities. And I think the difference is a lot of times our male patients will have had surgery or maybe having surgery for more of a prostate, prostate cancer situation or there is a sexual function involvement that tends to be a little bit more metabolic sometimes than hormonal.
Dr. Kara Fitzgerald: Absolutely! That makes a lot of sense. And then we see testosterone drop, estrogen increase considerably in that population.
Okay, so you touched on this when you addressed the mind/body piece. But some of these individuals with chronic, pelvic pain have shared some commonalities with the chronic pain picture in general. And then some are unique to the pelvic pain patient. Anything that you want to add to that?
Jessica Drummond: I think the big difference is that it’s because of impact relationship. It impacts their intimate partnerships and it impacts their sex lives. It impacts the basics of being able to go to the bathroom or not at certain times. So there can be a lot of shame involved different from someone maybe who has chronic headaches or chronic fibromyalgia where there’s just general pain.
There is some shame involved in not being able to fill some of those intimate roles that I think it’s important to be really compassionate and also helpful with in terms of education and collaborating with that patient’s partner as long as they’re open to that and just being really sensitive to sexual function.
I went to a really interesting lecture at the American Physical Therapy Association Conference earlier this year from a colleague of mine who was a physical therapist in pelvic pain and has become a sex therapist. And she works with traditional populations in Israel.
We call it physical therapy ADLs, their activities of daily life, so things like getting dressed, being able to walk where you need to, just being able to function in a very normal way. As a physical therapist, a lot of times, that’s the goal, getting our patients to be able to physically function in a way they need to live their lives.
And her lecture title was called Sex is an ADL. And I think we don’t think of that sometimes. Sex is merely more icing on the cake. But if you can’t have it, it’s something that can be lost and can really impact your relationships and your daily life.
So I think it’s important for clinicians to be really aware of that and examine their own beliefs about sexuality when they’re working with this population.
Dr. Kara Fitzgerald: Yes, that makes so much sense and a certain kind of sensitivity in this population is essential. Thank you for bringing that up.
So lots of our patients, lots of our female patients have been on birth control –sometimes, for decades, unfortunately – or even HRT, which is hormone replacement therapy. You’ve already brought up the hormone issue and it’s a big piece to the puzzle here, but how does that impact pelvic pain and other health risks in women?
Jessica Drummond: I think one of the most important things that a lot of women don’t know, I feel there’s a lack of complete, informed consent when women go in the birth control pill. They are not aware that sex hormone binding globulin can be elevated permanently, which is what birth control pills do. They raise this protein that makes inactive your own sex hormones and replace it with smaller amounts of sex hormones, which works very well in some women, and these other women with quite a few side effects. And one of them is directly, pain with orgasm.
So being on birth control pill can be a direct cause of sexual pain. But often, there are a few other key things. One is, of course, the hormone balance component. So once you come off the birth control pill, especially depending on if you’ve been on it for quite some time, the sex hormone binding globulin numbers can stay quite high and it’s very hard to get the sex hormones back up to normal. You have to address any adrenal fatigue because that can, of course, through the pregnenolone steal impact sex hormones.
But also, there is nutrient depletion. I think that’s really important for women who have been on the pill and then they’re trying to get pregnant because we know more and more about the intrauterine environment being pre-programming for that infant’s lifelong health.
And so the more we can have moms or women that are trying to become pregnant spend a few months really diving into detoxifying, but also nutrient repletion, building up these nutrients. And if they’ve been on the birth control pill, some of the most important nutrients of pregnancy have been depleted, things like B6, B12 and folate, impacting the homocysteine cycle; zinc, which can disrupt the zinc/copper ratio and cause increased oxidative stress; calcium and magnesium for building baby bones and not depleting mom’s bones along the way; and antioxidants like beta carotenes and vitamin E and vitamin C.
So these really essential nutrients for pregnancy can be depleted on the pill. So if I have a client who has been on the pill and would like to get pregnant, I recommend that she takes a few months and really build up her source before they start being depleted by the pregnancy.
Dr. Kara Fitzgerald: Yes, again, that’s just so many pearls, Jessica. I really appreciate it. I know folks listening value what you’re saying. You brought up methylation. It is a buzz word. I think that we can throw that into the overall mix. Obviously, methylation is key to being able to appropriately detox estrogen to safer metabolites and also detox myriad organo and metallotoxins and so forth. And it’s also involved, obviously, in DNA and the epigenetic regulation of DNA. I think you were alluding to that in preparing the uterine birth environment for generations to come really.
So anything you want to say on that? Have you been giving it thought at all?
Jessica Drummond: No. I just think you’ve got to make sure that, again, it comes down to education. You’ve got to make sure that women understand that – and without putting undue pressure on them because I think there’s enough pressure on pregnant women.
It’s a little tricky because this idea is that really, the health of the intrauterine environment can impact genetic expression going forward. So if they know if they have an MTHFR SNIP, for example, making sure there is plenty of methylfolate rather than taking junkie prenatal vitamins full of folic acid that can just build up without converting.
So yes, I think nutrient repletion and preparing the intrauterine environment also with probiotics and probiotic food, making sure the microbiome is in good shape. We used to think that babies were not really colonized with their own bacteria until delivery. But we’re now finding more of a microbiome in the placenta. So it can start even sooner.
Dr. Kara Fitzgerald: That’s incredible! I really appreciate the concept that Dr. Michael Stone brought to my attention, the methylation diet and his OBGYN wife, Dr. Leslie Stone. So just in individuals with either homozygosity or heterozygosity with the MTHFR or even other methyl issues, even a few identified imbalances in laboratory data (B12, homocysteine, et cetera), methylation diet, again, our green leafies, nut seeds, et cetera.
So it’s really the diet where we’re all migrating towards anyway. So that jumped to mind.
Just going back to chronic birth control exposure and the imbalances, again, thank you so much for bringing that to our attention. So really, refractory sex hormone binding globulin is high all the time. Any pearls for how we might work with that?
Jessica Drummond: I do think it comes to helping support the liver and also the kinds of food that raise estrogen.
So it’s funny. We’ve been having a lot of conversations in my student group online about pomegranate. And pomegranate is a very interesting food (you can now get it in extracts) that has been used in fertility since, essentially, they had Greek gods and Roman gods.
And then the Christians took it up and there is actually a church in Italy for the Madonna of the Pomegranate where they had ceremonies every year even to this day for fertility.
It’s very interesting because there is so much data now linking improvements and even menopausal symptoms for taking pomegranate either as food or really, the studies are done with supplements.
I think that’s using these super foods, which are really just super healthy foods that exist as a part of the diet to nourish, give your body enough nutrients to make hormones, plenty of fatty acids, enough cholesterol to make enough hormones. Too many women are on low fat diet for extended periods of time. They need to be on healthy fat diet.
So I think it’s a combination of those things, the support of the liver and also increasing the raw materials available to make sex hormones.
And the other thing that increases raw materials available to make sex hormones is increasing the juiciness of life. If a woman is not so stressed out, if she has some relaxation time, if she has the ability to receive care and support and ask for and receive help, it calms, it induces the relaxation response which is the only opportunity to make sex hormones. If you’re chronically stressed, they’re being chronically depleted.
Dr. Kara Fitzgerald: Absolutely! Yeah, that’s beautifully said. I am personally going to go worship the Madonna of the Pomegranate. Thanks for [inaudible 00:38:45] me to that. Ah, that’s great. I’m dying to see an image of the Madonna of the Pomegranate. I’m going to look that up after we’re done.
Jessica Drummond: Yeah, we talk about that in my course.
Dr. Kara Fitzgerald: That’s just really, really cool. I love pomegranates too. It’s just a sexy fruit.
Jessica Drummond: It’s awesome! One of my good friends is a historian. She and I had a really great conversation about that. So now, I teach it. It’s great!
Dr. Kara Fitzgerald: I love it. I love it. Okay, let’s talk about post-partum women. Painful sex, pelvic floor weakness, core weakness, how do you address that from this holistic perspective, the functional perspective?
Jessica Drummond: So again, I’ll be collaborating with PT and fitness colleagues to help women regain their core and pelvic floor strength post-partum. But also, I think what nutrition can really add.
So we do well, I guess, with not just kegel exercises, but we’re certainly strengthening the entire core and pelvic floor strengthening, the glut’s strength and having women reconnect to the pelvic floor. A lot of times it’s not even a weakness issue, but when you’ve delivered a baby, things are overstressed, your nerve connection has been lost, and sometimes it’s not enough to just get a pamphlet that says, “Hey, go home and do kegel.” You really need to have someone explain to you what that means, and specifically, in your body.
And also really common is diastasis recti. The abdominal muscles can simply split and be overstretched. The fascia between can be overstretched. And the hormonal environment of breastfeeding can make [inaudible 00:40:42] to continue for a period of time. The ligament laxity, the connective tissue laxity can continue. And if women are breastfeeding for two years, which is the WHO recommendation, which is great for babies, but also moms need to be educated that going back to power lifting or jumping on trampolines may not be the right thing exactly right now. Not to say you can’t, but you want to rebuild that core stability and give the body some patience.
We have so much pressure on post-partum women for getting back in your jeans. The conversations about the new princess who just had the baby in England. Ten hours later, she was standing in heels outside greeting everyone. That is obviously a very unique case, but the point is, in general, we have a lot of pressure on post-partum women to bounce back as quickly as possible.
And if they’re breastfeeding, which is really important (and we want to encourage that) we need to give them – and even if they’re not because they’re just tired, they had an infant.
I worked in a women’s hospital for about eight years off and on. The gynecologist delivered about 10,000 babies a year, which is roughly one every hour. There were tons.
And one of my bosses once said, “We used to educate a lot of the post-partum women,” and she said, “Look, a C-section is the only major abdominal surgery where they send you home without any physical therapy and they give you an infant to take care of.”
Dr. Kara Fitzgerald: Sheesh! Yeah. Yeah, the demands are incredibly high.
Jessica Drummond: [inaudible 00:42:30]
Dr. Kara Fitzgerald: No, I’m just agreeing with you. I know. And the media doesn’t help. Look at celebrity x post-baby body. It’s really nuts. So thank you for that.
Jessica Drummond: That’s the first thing. And then I think the second thing is just nutritionally, we can support that healing and strengthening of the collagen with things like collagen, grass-fed protein powders, with bone broth, with nutrients that support the health of collagen like vitamin C and hyaluronic acid and sulfur and lutein. There are a lot of nutrients that really support collagen healing.
And if women post-partum are really exhausted and they’re not eating well and they’re just having fast food and barely sleeping, they don’t – again, kind of like the situation of hormones – they don’t have the raw materials to have their body recover well after pregnancy.
Dr. Kara Fitzgerald: Absolutely! Very, very good point. I was thinking myself the demand for amino acids and all of the associated nutrients, cofactors and coenzymes as you have mentioned, essential for the healing process.
Well, as we come to the end of this extremely informative conversation, let’s talk about the menopausal women and some of the challenges you see in your practice. How do you address them? Why don’t you give me the top three challenges that you see with them, the menopausal individual?
Jessica Drummond: I really think this starts with addressing perimenopause. A lot of my clients are in their mid-40s and are experiencing symptoms of hormonal imbalances certainly, the hot flushes, the mood swings. And I think that is the thing, that anxiety, depression that can come on, the brain fog, that’s what seems to bother women the most. Absolutely, I don’t blame them.
So a lot of times, I look at things like adrenal fatigue and also thyroid imbalances. Hashimoto is still common. And again, looking at that whole person approach of her stressors, her micronutrient deficiencies, her hormonal imbalances, liver toxicity or overexposure to environmental chemicals, the kind of adrenal, thyroid, sex hormone imbalances is very common.
Second, I see a lot of women with looking to strengthen their bone health. They’re feeling like the clock is ticking.
And one thing that I want to bring up about this that I think some people don’t – a lot of clinicians think about calcium rich food and that sort of thing, but women who have pelvic health concerns in this age range who are struggling with something like incontinence aren’t really willing to do a lot of impact exercise, which they really need.
So sometimes, if a woman is fearful of doing these things or avoiding it for some reason, you might want to look at her pelvic floor health and collaborate with a physical therapist.
And then weight loss goals. And again, metabolic syndrome is really, extremely common in this population. And so we want to get to the root of that, whatever it may be in that individual woman’s case.
Dr. Kara Fitzgerald: Thank you. Yes, I think just the full functional approach that you’re talking about, there is so much overlap. What you shared is inspirational. Functional medicine, clinicians, really, of any stripes, can do so much for this overall population of any individual struggling with pelvic pain or any of the issues we’ve touched upon today. I think there is much we can do.
Thank you so much, Jessica. And I just wanted to let everybody know again that –Jessica – well, first of all, all of her contact information is available on the site. And if you are a clinician and need some support in identifying a good PT that you can collaborate with, you can reach out to Jessica. If you want to refer somebody to Jessica, the information is there. And again, she is the founder and CEO of the Integrative Pelvic Health Institute. So if you are interested in that training as a clinician, you can reach out to her. Thank you so much.
Jessica Drummond: Thank you for having me. It was my pleasure.
Dr. Kara Fitzgerald: You are welcome. Okay, take care. And good bye, everybody. Thanks for joining me. Again, I’m Dr. Kara Fitzgerald on this podcast.
Jessica Drummond, MPT, CCN, CHC, the Founder and CEO of the Integrative Pelvic Health Institute is passionate about caring for and empowering women who struggle with women’s and pelvic health conditions.
She is equally passionate about educating and supporting clinicians in confidently and safely using integrative tools to transform women’s and pelvic healthcare.
Having over a decade of experience as a women’s and pelvic physical therapist plus owning a private women’s health clinical nutrition and coaching practice gives her a unique perspective on the integrative, conservative options for pelvic pain management.
Jessica was educated at the University of Virginia, Emory University, The Institute of Integrative Nutrition, and Duke Integrative Medicine. She is currently a doctoral student in clinical nutrition at Maryland University of Integrative Health. Learn more about working with Jessica to heal your health issues.