The Buena Vida Podcast

Bijal Toprani, DPT: What we need to know about our pelvic floor

• Lacy Wolff • Season 4 • Episode 6

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Ever sneezed and leaked a little? Felt an urgent need to use the bathroom the moment your key touches your front door? You're not alone—and contrary to what many believe, these symptoms aren't just normal parts of aging or motherhood that you have to accept.

In this conversation with Dr. Bijal Toprani, physical therapist specializing in pelvic floor health, we unpack the hidden world of pelvic floor function and dysfunction that affects up to one-third of women. Dr. Toprani demystifies what exactly the pelvic floor is (those muscles extending from pubic bone to tailbone), the common issues that arise (from various types of urinary incontinence to pelvic pain), and why waiting an average of six years to seek help is unnecessarily prolonging your discomfort.

We challenge widespread misconceptions, including the belief that Kegels are the universal solution (they can actually worsen certain conditions!) and explore the fascinating connection between stress, trauma, and pelvic tension. Most importantly, Dr. Toprani emphasizes that these conditions are highly treatable, with many patients seeing a 50% reduction in symptoms within just three months of consistent therapy.

For Health Select of Texas and Consumer-Directed Health Select participants, there's now a convenient virtual option through Hinge Health that eliminates the typical three-month wait to see a specialist. Whether you're experiencing issues during pregnancy, postpartum, perimenopause, or any stage of life, this episode delivers practical insights that can transform your relationship with your pelvic floor and overall quality of life.

Take the first step toward addressing what's been normalized but shouldn't be. Your pelvic floor deserves attention, and relief is more accessible than you might think. Listen, learn, and reclaim control of this crucial but often overlooked aspect of your wellbeing.

Learn more about Hing Health's Pelvic Floor program and see if you may be eligible through the HealthSelect website.

Dr. Toprani:

I think that there needs to be a rebrand for pelvic health. You know that it's not a nice to have, it's a need to have. It is a very small region of the body but it has all the muscles, the ligaments and the fascia that are really essential for everyday functions things we do all the time.

Lacy Wolff:

Welcome back to the Buena Vida podcast, where we explore practical ways to support your well-being body, mind and everything in between. I'm your host, lacey Wolfe. In our episode today, I'm joined by Dr Bijal Toprani, who is a physical therapist with Hinge Health. We talked about something that I think doesn't get talked about quite often enough, and that is pelvic floor health. The truth is, pelvic floor dysfunction is incredibly common, but many people suffer in silence, unsure of where to go or what's normal. We're going to change some of that today. In our conversation. We discuss the pelvic floor, what it is and why it matters, common dysfunctions and symptoms to look out for what assessment and treatment actually involve, and our new pelvic floor program from Hinge Health, available since January for eligible Health Select of Texas and consumer-directed Health Select participants.

Lacy Wolff:

Whether you're eligible for this program or not, this episode is packed with valuable information and insights that can be foundational but often overlooked and helpful in your own personal life. So I hope you enjoy our conversation. Let's get started. So, dr Toprani, thank you so much for being with us on the Buena Vida podcast. I'm looking forward to talking with you about all things pelvic floor and Hinge Health. Thanks for having me. Yeah, we are going to. I want to dig into the new offering that is available for our health plan participants and that is the pelvic floor program, and you are a doctor of physical therapy and specialize in pelvic floor. Can you talk to our listeners just a little bit about why did you get into this pelvic floor in the first place? Where did that come from?

Dr. Toprani:

Sure. So when I went to physical therapy school, you know our curriculum pretty much starts out where you're dealing with orthopedic conditions, so things that people know a lot about sprains, orthopedic conditions, so things that people know a lot about sprains, strains, low back pain, shoulder pain, and then it kind of transitions to teaching you about neurological conditions.

Dr. Toprani:

So if, god forbid, anyone has a family member that's ever had a stroke or a spinal cord injury, they might have seen a PT work with somebody in that world, and then there's also pediatrics in that world, and then there's also pediatrics, but pelvic floor care, even within physical therapy school, it's not really talked about that much. In other words, it's like very niche. And so I got really interested in it because I was intrigued by learning more. You know why isn't there so much more awareness about it? How does what I already know about the human body and anatomy translate to treating pelvic floor care? So that's really what kind of got me interested and started. And then I always my mom always calls me a rebel without a cause, but I think I have a cause but I always like try to look for patient populations that are more underserved, and so pelvic floor and like women's health, is definitely one of those areas, and so that made me kind of think like what can I do to improve care for that type of population?

Lacy Wolff:

And that's why I decided to go into it. That's amazing, wow. And can you explain to our listeners, who may not have a really extensive background in exercise physiology or human anatomy, what is the pelvic floor, what specific muscles kind of make up the pelvic floor and what does it do for us?

Dr. Toprani:

Yeah, so the pelvic floor is the muscles that go from your pubic bone in the front to your tailbone in the back. So it is a very small region of the body but it has all the muscles, the ligaments and the fascia that are really essential for everyday functions things we do all the time like going to the bathroom so all your bowel and bladder function, sexual health, of course. If you ever have a baby, this is the region that you know that the vaginal delivery occurs from, and so very small, like I said, that region, but it's really those muscles that make up the bottom of your bowl shaped pelvis are very important, obviously for the reasons that you said, and there are a lot of pelvic floor challenges that people face.

Lacy Wolff:

It sounds like there's a lot of disorders around the pelvic floor and I believe from your website it's one in four women struggle with a pelvic floor dysfunction. Is that true?

Dr. Toprani:

Yeah, About 25 to 33% of the female population.

Lacy Wolff:

Wow, yeah, and so many people are not reaching out for support, right? So could you talk about maybe some of the more common dysfunctions that you see in your practice, and what kinds of conditions?

Dr. Toprani:

Sure, the most common ones I see are urinary incontinence, so that's leakage of urine that can happen during certain activities. So we kind of, as pelvic health therapists, split up urinary incontinence or leakage into three categories. The first is what we call stress incontinence, so that's when you're leaking urine when you cough or you sneeze, when there's like an increase in pressure urine when you cough or you sneeze, when there's like an increase in pressure and leaking urine with exercise also kind of falls into that category. Jump rope, jump rope trampoline there was like a viral trampoline video about you know women that were, you know, dealing with that during that type of activity.

Dr. Toprani:

And then there's urge incontinence, and that's where your muscles aren't necessarily weak but your brain keeps telling your bladder it's time to empty. So this can happen sometimes when someone's like opening their front door of their house. The second they put the key in the door, they start to feel like this urgency that they have to go right away, and sometimes people in that situation can't hold it and so that's another type of leakage. And then there's also the mixed version, which is kind of a combination of the two. So that's the most common condition that I see in my practice.

Lacy Wolff:

What are some signs? I mean, you've given some signs already. You know around leakage, but what are some things that people should be looking out for, like when is it time to get help for pelvic floor?

Dr. Toprani:

There's actually a criteria that was built by a really well-known pelvic floor PT and it kind of goes through a list of different things you can look out for. So some of the things on that list are urine leakage, Like I mentioned. If you're getting up in the middle of the night to go to the bathroom more than two times a night, that could be a sign that you have some sort of pelvic floor dysfunction or urgency. If you've ever fallen on your butt or your tailbone or your back, like even when you were a little kid sometimes, if you did gymnastics and you, like fell a lot, that can lead to toxics or tailbone pain later, which is also related to pelvic floor. If you have pain with intercourse so pelvic pain, pain in the lower abdominal region those are all signs that you could definitely benefit from pelvic floor physical therapy. And then also things related to constipation, so if you're chronically unable to have a bowel movement easily, that's also a sign of pelvic floor dysfunction.

Lacy Wolff:

Okay, men can also have pelvic floor challenges, correct they?

Dr. Toprani:

can yeah?

Lacy Wolff:

But our program right now is for women, so we're kind of focusing on that today. But during pregnancy or there are certain stages in a woman's life that maybe there's more strain on the pelvic floor. Can you talk a little bit about that?

Dr. Toprani:

Absolutely so. Pelvic floor conditions can really pop up at any time, but there's definitely an uptick or an increase in them around pregnancy, during the postpartum phase, okay, and then around perimenopause and menopause and those kind of get used, you know, interchangeably but essentially, if you're having a decrease in estrogen, so around perimenopause maybe your menstrual cycle is getting a little bit more irregular, that can also lead to pelvic floor issues. So those are the three most common life stages.

Lacy Wolff:

And can you explain what's happening there with the estrogen decrease and the perimenopause?

Dr. Toprani:

Yeah, so estrogen receptors? They live on a lot of different parts of our bodies and specifically they help your vaginal tissue stay really elastic and really lubricated. Okay, so when your estrogen declines it can cause the muscles to become a little less flexible, a little less elastic, interesting and they can get like dry and a little painful with intercourse and then, also, because they're less elastic, sometimes they don't contract or relax the way that they're supposed to to like keep you dry, or you know, in other words, you might not be able to do a Kegel contraction properly if you have a decrease in estrogen.

Lacy Wolff:

Okay, so you said Kegel, yep, and that's kind of a good transition, because I want to talk next about what pelvic floor therapy looks like. What would someone expect during a session? And I would love to have you kind of walk our listeners through a kegel exercise. I think that would be really, really nice because we can do it anywhere you can you can.

Dr. Toprani:

So with the Hinge Health Program, what you can kind of expect is we want to first understand your symptoms. So we want to know whether you're dealing with leakage, because leakage is going to be a whole different set of exercises than if you're dealing with pelvic pain. So we're going to start with asking you questions regarding that and then, when you meet with the pelvic floor PT, we want to again maybe talk you through a Kegel exercise. So, for example, if we were all going to do one now while we're on this podcast, kegel contraction is essentially trying to bring your pelvic floor up and in towards the center of your body, and that includes also squeezing the muscles around your anus, and sometimes we use imagery to help people so you can kind of relax again and then imagine trying to like, pick up a blueberry with your pelvic floor muscles and kind of closing the pelvic floor around that blueberry and then relaxing back down, and so that is maybe the set of exercises that you would do if you had weakness of the pelvic floor and we had to kind of assess whether you could contract or relax.

Dr. Toprani:

So for some people on the line maybe I was saying this and you weren't really feeling the ability to do that down there. Maybe for other people they were like oh, I totally get it. So we assess that while you're meeting with the pelvic health PT and we'll ask questions oh, are you getting that sensation? Do you feel like you're able to contract? You know, do you feel like you're contracting more on the backside of your body or the front side, and kind of tease out whether you can really contract your pelvic floor. And then, once we get that baseline, we know where to go from there.

Lacy Wolff:

Okay, and can someone have too much tension and you wouldn't recommend also maybe doing a Kegel? Yes, okay.

Dr. Toprani:

So I think that Kegels have gotten a lot of PR out in the world right, Like every woman knows about Kegel exercises, and that can actually be dangerous not to be dramatic, but it can be so. If you're someone that has pelvic pain whether that means that you have a diagnosis like endometriosis and you're getting a lot of pain in your pelvic floor just at rest, or you have pelvic pain when you have intercourse with your partner, that is a sign that you have tension in your pelvic floor, that those muscles are really tight and maybe they're always in that Kegel contraction and they actually need to relax to make your symptoms better. So Kegels are not always what should be prescribed to everybody with the pelvic floor dysfunction. It really matters what type of pelvic floor issue you have to then decide whether Kegels are beneficial or not.

Lacy Wolff:

Okay, that makes so much sense. So if you were out there doing the Kegel, maybe you should not have been necessarily doing it, but for most people would you say that the issue is the weakness and not the overstraint, or is it a?

Dr. Toprani:

You know, I don't know the stats off the top of my head, but I feel like most of the time, folks that have gone through pregnancy and are in the postpartum stage and are more in that life stage or are in perimenopause, they tend to have more weakness of the pelvic floor, which they would benefit from Kegels for Sometimes. Younger patients, like those in their early adulthood who haven't gone through that but have pelvic floor dysfunction, tend to have more tightness of the pelvic floor.

Lacy Wolff:

Okay.

Dr. Toprani:

So those are broad generalizations, but if you are having urine leakage and you don't have any type of pain of the pelvic floor, it's a pretty good sign that it's due to weakness and that Kegels would help Okay.

Lacy Wolff:

Yeah, that's so helpful. We know that there's a connection between the brain and the body and I think stress sort of impacts everything in our body. Would you say it affects pelvic floor.

Dr. Toprani:

Absolutely it does. You know, a lot of patients that I've worked with the ones that have pain in the pelvic floor sometimes have had a history of some sort of sexual abuse. Or maybe there's been some sort of history where there's a fear of a vaginal exam at like your doctor's office and that can kind of cause you to feel a lot of tension which translates into the muscles actually tightening up. So fear and history that all starts in from a mental health perspective can cause you to then tighten up or tense up, which can cause you to feel more pain sometimes in the pelvic floor region.

Lacy Wolff:

Wow, that makes so much sense. Are there any misconceptions around pelvic floor therapy that you would like to clear up for our listeners?

Dr. Toprani:

I think that pelvic floor therapy I kind of started off talking about all the different types of PT that exists in the world, you know, and I think people think, oh, I sprained my ankle, I need to go to physical therapy. Or, you know, I have frozen shoulder, I need to go to physical therapy. But pelvic health isn't really something people automatically think oh, there's PT for that, right. And so I think the misconception is more around like awareness in and of itself that this is an actual expertise that exists, that there are pelvic health PTs like me who have gone through training, that are, that are specifically trained to treat this region.

Dr. Toprani:

And the other misconception I would say is that I think folks think that even when they are bought in to going to pelvic health PT, that it might not be that effective or like is it really going to get better?

Dr. Toprani:

And I think the reason why is because a lot of women have kind of just dealt with these symptoms for a long time.

Dr. Toprani:

Like we see in the literature that it takes about six and a half years for a woman to talk to a provider about pelvic health symptoms, and I think that really speaks to the fact that women are just kind of like oh well, you know, I had a couple of children or I'm aging, that's just kind of a part of life. And I know a lot of my patients will talk about their mothers and grandmothers who just wore, you know, depends or wore adult diapers for years and years and years because they had kind of resigned to the fact that this was just a normal part of life, and so that's really a big misconception that I see that I want people to realize that, like common doesn't mean normal and common doesn't mean that it's not treatable. It's an incredibly treatable condition and we have people in our program that have reduced their urinary incontinence symptoms by half. So if they're leaking five times a week, they're only leaking like two to three after like three months of being really committed to their exercises.

Lacy Wolff:

So very treatable and yeah, that's amazing and I just from my own personal experience, I've been going through the pelvic floor program. I am 46. I've had two kids and I'm one of those people that kind of resigned to this. This is normal and it's not terrible. It's just here and there, but I like to go through anything that we're recommending for our health plan participants and it's been a game changer. So I am grateful we can have you on and hopefully get this information out to everybody, because it does. It has hugely impacted me personally as well. You have worked from patients, according to your bio, from ages two to 102, which is amazing. How can the pelvic floor health change during different life stages? You talked a little bit about women and aging, but just generally, what can people expect?

Dr. Toprani:

Yeah, so my expertise is definitely with the populations that I've already talked about. You know the pregnancy, postpartum, menopause and then early adulthood, but there are pediatric use cases for pelvic health PT. That's another like niche of a niche specialty. But if there are issues around bedwetting, around potty training in general, chronic constipation, which is really common in young children, that is something that Pelvic Health PT can help with. Of course this program is for 18 and over, but that's just for a knowledge check there. And then, like I mentioned, early adulthood is where you're kind of seeing some of the more tightness-related issues, whereas weakness-related issues tend to happen around pregnancy, postpartum. There's also pelvic organ prolapse, which can feel like a heaviness of your pelvic floor, like your pelvic organs are kind of slipping out of their normal position, which sounds scary, but it's again very treatable. That's another thing that we see. If you've had multiple births and maybe you've had labors in which you've had to push for many hours, that can kind of cause extra strain on your pelvic floor which causes some prolapse related issues.

Dr. Toprani:

Yeah, you should definitely start, which, by the way, you're such a good patient, so that makes me happy but you should start to see improvements within that three-month period. Like I said, we're kind of seeing 50% improvements at three months and then more of like a resolution of much, much better within, you know, three months after that. So like a six-month period. It depends how severe your symptoms are. How severe your symptoms are, but especially with urinary incontinence, there are lifestyle things that you can start to implement kind of immediately that will give you relief pretty soon. So like, for example, not going to the bathroom just in case we call that gig.

Dr. Toprani:

Um, and so you know, we kind of all grew up like oh, we're going on a road trip Like Go to the bathroom, just in case, even if you don't have to, we call it preventive pee, there we go.

Dr. Toprani:

Preventive pee, and so preventive peeing actually tricks your bladder into thinking that it has to empty, even when your bladder is not full. Oh, so you really shouldn't even be going to the bathroom until your bladder is full. And how do you know your bladder is full If you sit down on the toilet and you start to pee, you should be able to count to 12 to 15 Mississippis. What, yeah, like one Mississippi, two Mississippi, three Mississippi, and that is a sign that your pelvic, that your bladder, was actually full and needed to be emptied. Wow, if you're counting Mississippis and it's like four, you might've done a preventive P or a JIC.

Lacy Wolff:

A JIC. Yeah, okay, that is so interesting. I love it. I'm going to start working on that. So what advice do you have? I know we talked a little bit about the fact that everyone has a pelvic floor, men and women. What advice do you have for men that may, and what kinds of challenges do men have with pelvic floor? What advice do you have for men that may, and what kinds of challenges do men have with?

Dr. Toprani:

pelvic floor With pelvic floor conditions, if you are someone who gets diagnosed with prostate cancer and then goes through the treatment for prostate cancer.

Dr. Toprani:

Oftentimes after that you can have urinary incontinence and sometimes there's even erectile dysfunction that can occur from that.

Dr. Toprani:

We also have men that have chronic, like hamstring and groin related pain, which is common in like athletes that do a lot of kicking, like soccer players or hockey players, where their groin is like an area that is used a lot with a lot of skating that they do A lot of times. When your pelvic floor is weak, it can cause issues in other surrounding muscles, like your hips and your hamstrings. So those are types of things that men may experience related to the pelvic floor, okay, and so my advice for them would be you know, if you're already in the Hinge Health program and you're in for another body part, you can message your pelvic. You can message your PT, excuse me, and just say, hey, I'm having these issues and there are some resources within the program that are for men that we can send over to you, okay. Or you can always find a pelvic health PT to work with in person if you go to pelvicrehabcom. But yeah, men have pelvic floor issues too and they definitely deserve care for that.

Lacy Wolff:

Let's talk a little bit about what someone might do if they are interested in getting support with pelvic health issues. What's the first step that someone might take?

Dr. Toprani:

Yeah, the first step is you should might take. Yeah, for the first step is you should definitely look into the Hinge Health program. So if you go to hingehealth, slash health select, you can learn about the program and then also fill out an application on there. That is the first step and then from there you're kind of off to the races, because we'll set you up with the exercises that you need. We'll have you download the Hinge Health app, lacey you mentioned a moment ago. We make it so that the exercises are really approachable. That's by design. So the first step is really getting enrolled in the program at that website and then filling out an application.

Lacy Wolff:

And it's all virtual. So just for our listeners that may not be as familiar with Hinge Health, yet it is all virtual, but you can, there are. I mean, we want to make sure people know that you can also go through your healthcare provider, your PCP, and get referred for pelvic floor therapy. But from what I understand and having friends who have had to go, who have needed that support, it can take a long time to get into a pelvic floor therapist right. There aren't enough of you, there aren't enough of us.

Dr. Toprani:

No, it can take a really long time. It can take like three months in most metros. So, like San Francisco, austin, new York, it can take like 93 days, to be exact, to get in to see a provider, a pelvic health PT. So that's actually why I like this program so much is because I know that when there's months of time between me doing the thing that I need to do, it's going to fall off my list. So with this it's really nice because you can get started right away and you don't have to leave the house and I know for some of my patients it's kind of an uncomfortable topic too for some folks, and so it's really nice to have that privacy Right. But yeah, we can get you started right away, which is really nice, amazing.

Lacy Wolff:

And I know for me personally. You said I'm a really good patient, but actually I was a really good patient for a while and then I got sick. I had this terrible cold and it was 10 days and I was coughing so much that all my symptoms came back and I felt like, oh man, I did all that work and then it's just for nothing. And then I was discouraged and I started back and within a couple more weeks I was back to where I was. So it's amazing how quickly you can make progress with the program. I really love the consistency and the tracking and you know, it's just gamifying healthy behaviors is what I love about your program.

Dr. Toprani:

Absolutely, and I know you're an enthusiast on like habit formation and all of that and I've read the book Atomic Habits and it's really all about that fitting in. You know, 10 minutes, 15 minutes. If you can only do it twice a week, great. If you progress to three days a week, awesome, Like. We're here to really applaud and support people, regardless of what their starting point is. So if you do have any apprehension, any listeners that are like I don't know if I can commit to this, it's better to just take the first step and you know we'll definitely meet you where you are.

Lacy Wolff:

So in your coaches so gently nudge.

Dr. Toprani:

Yes, I call it gentle nudges too. Yeah, we have amazing, amazing health coaches who are their entire goal and ethos is really to be your support system. So they want to reach out to you and say, hey, lacey, haven't seen you in the app in a while. Uh, how can I help you? What's going on? You know, they're not here to judge, they just really want to support you. And if your answer to them is, hey, life is lifing right now. I need a little bit of a break, like, that's okay too, and they'll touch back with you in a few weeks, yeah, and they're not.

Lacy Wolff:

They're not on you every day, but I really appreciate that support through the program. All right, so what? I have just a couple more questions here for you, and I know we're at time, but I could talk about this all day. What is one takeaway you would?

Dr. Toprani:

like for our listeners to take away around pelvic floor health. I think the common is not normal thing. I think that there needs to be a rebrand for pelvic health. You know that it's not a nice to have, it's a need to have. Based on my research on the standard of care in other countries, for example, in France, if you have a baby, the standard of care is that you go to six pelvic health PT visits.

Dr. Toprani:

Okay, that's just the standard, wow, and I think that says a lot, because normally here a postpartum visit is six weeks post-op, I mean post-delivery, like okay, are you good, you know you don't have an infection. Okay, great. Like good luck with the rest of your life.

Dr. Toprani:

And it's really unfortunate. And so you know, I think my biggest takeaway is that, like, you deserve to get care for this, and just because the standard is not you know what it is the six visits like let's remake that standard for ourselves and really get the support that we deserve, right?

Lacy Wolff:

So, yeah, especially important for postpartum, and anyone can join the join the program. So, all right, uh, very last question, and then we'll talk about where people can go for more information. This podcast in our wellbeing program is called Buena Vida, which means the good life, and we're really trying to emphasize that a good life can mean different things for different people. What is a good life? And we're really trying to emphasize that a good life can mean different things for different people. What is a good life for you?

Dr. Toprani:

A good life for me is having a really good mental health perspective on things. You know, I've worked a lot in the last couple of years like going to therapy and figuring out how to grow and how to be more confident and how to take care of my mental health, and I think that that has trickled down into everything that I do my work, my relationships and so I think living a good life is having the time to pour into yourself and your mental health and your mental well-being as much as you possibly can.

Lacy Wolff:

That's great. I love that. All right. Well, I know that you have the eligibility requirements for Hinge Health, so do you mind telling people the requirements for the program? If anybody's interested in, I will also put all of this in our show notes as well. So if you're wanting to get involved in the pelvic floor or hinge health in general, you can look at the show notes.

Dr. Toprani:

Yes, absolutely so for ERS participants. Those that are on the Health Select of Texas medical plan, including those that are enrolled in the consumer directed Health Select and are over the age of 18, consumer directed Health Select and are over the age of 18 living in the US are eligible to enroll in Hinge Health. So if you do want to learn more, you can go to hingehealth slash health select where you can sign up for the program.

Lacy Wolff:

Awesome, you are amazing. Thank you so much, really, really grateful for your time, your energy and all you're doing to help support our health plan participants. Thanks for having me. Thank you All right. That wraps up our episode for today. Thank you so much for listening to this important conversation. Pelvic floor health impacts more people than we realize, and the more we talk about it, the easier it becomes to find the help and the support we need. If you think someone in your life could benefit from this information, please consider sharing this episode with them, and if you're interested in learning more about the Hinge Health Pelvic Floor Program, if you are a Health Select of Texas or Consumer Directed Health Select participant, please check out our show notes, where you will find the link to the registration process. Until next time, take care of yourself and your pelvic floor. Have a great day.