Why Pelvic Health Therapy Matters and How It Impacts Your Daily Life, with Dr. Chelsea Tetreault PT, DPT

As part of our Expert Spotlight Series, our founder Lauren chatted with Dr. Chelsea Tetreault PT, DPT. Chelsea is a Doctor of Physical Therapy from North Kingstown, RI, who specializes in women's pelvic health and orthopedics. With a DPT from the University of Vermont and a background in Exercise and Movement Science, she offers an integrated approach to helping women live their healthiest lives, from pregnancy to postpartum. Inspired by her experiences as a gymnast and collegiate athlete, Chelsea is passionate about the connection between movement and health. Outside the clinic, she teaches aspiring therapists, collects houseplants, and enjoys adventures with her husband and dog.

In their chat, Lauren and Chelsea discuss how pelvic health plays a vital role in everyday life, affecting everything from bladder and bowel function to core strength and pain management. Chelsea explains why pelvic health is so important, who can benefit from pelvic floor therapy, and how simple daily habits can promote long-term wellness. They also explore how pelvic floor physical therapy can help overcome challenges and rebuild confidence, whether you're recovering postpartum, managing pain, or navigating other life changes. And, if you're hesitant to seek help, Chelsea shares her recommendation for a first step toward feeling better.

Check out 5 of our highlights below, or catch the full conversation on YouTube!

 

1. How Pelvic Health Shapes Your Everyday Life: A Focus on Function

Lauren:

If you're explaining the importance of pelvic health to someone who's never heard of it before, how would you do that?

Chelsea:

I always relate it back to function. People tend to know what they can do with no problem in their day-to-day life, and then where they have a harder time. So functionally, people know if they have a shoulder injury, sometimes bathing or getting dressed or lifting their kids in and out of the car can be difficult. But we'll talk about more functionally how our bowels, how our bladder, how our core, all of that functions.

And from there, if someone is like, "Oh, well, what are some of the things they might be experiencing?" We might talk about bladder symptoms, bowel symptoms. I feel like it usually comes up pretty organically when someone has questions about what I do. There's one specific girls night I remember where I was at my friend's house and there were six girls there, and once we sat down after dinner, my friend who was hosting was immediately defaulted to this pain position on the couch.

And I asked her, "Are you feeling okay?"

And she said, "I am so nauseous. I've been constipated all week.".

So I asked her, "Do you have a plan?"

And she was like, "No, I have no idea what to do."

So I asked, "Do you want some tips? You don't have to take them, it's girls night, but you want them. I'm really happy to help." So I taught her how to do a bowel massage and I had her just do some stretches with her legs up on the wall, and I'm not kidding, that week out of the six girls that were there, at least three of them texted me that week and were like, "Oh my gosh, Chelsea, I did the things and I've never pooped better in my life." So it's things like that. That whole group of girls that I worked with, they weren't sure what I necessarily do for work.

And then it just kind of comes up and we talk. As I was talking about it, they're like, "Wow, this is so cool. I didn't know pelvic floor PTs did that." It also makes me feel really old because the girls and I now talk about bowel movements, but I feel that why when I talk about function, it all comes back to the fact that people know what they're having a hard time with, because we think of it from a lens of with musculoskeletal pain as activities. Whereas daily function is still something that, as physical therapists, we can help patients with.

Lauren:

I think that's funny just how our conversations do change as we get older. But the point about too, when you kind of talk about it for one thing and then it brings it up for others, I've found that's true even for myself where I will start talking about these things more and more. Especially with me having pelvic organ prolapse after my first kid, some of the things where it's like I had never talked about that or heard about it before, but then you talk to more and more people and they're like, oh, my aunt has that, or my friend has that, or my mom has that, or I think my mom had that. It is interesting, the more we talk about these things, the more that so many people who are very close to us are dealing with it. So that's something I've experienced a lot over these last few years.

Chelsea:

I love that people are talking about within their comfortable circles of who they're comfortable with, they're bringing it up more.

 

 

2. Who is Pelvic Health Therapy For? The Answer Might Surprise You!

Lauren:

I know we're seeing more and more information on pelvic health and then along with that of course comes some misconceptions. What are one or two that really rub you the wrong way and that you see a lot?

Chelsea:

Yeah, I think one of them is who pelvic health therapy is for. That's a really common misconception. Obviously I have a passion working with patients who are pregnant and postpartum, but even a lot of my friends will say, "Oh, I'm coming to you when I'm pregnant." But they might have pelvic floor things before pregnancy and postpartum or after pregnancy and postpartum. I see gymnasts who leak when they're tumbling. I see patients who have endometriosis and have pain that they're working through. I have patients going through menopause who have symptoms. We have patients who are being seen after prostate surgery. We have pediatrics seeing pelvic floor physical therapists. We have a lot of neuro population patients who need pelvic floor physical therapy because the bladder changes. So I think one of the biggest misconceptions is who it's for. It's great that it's definitely maternal healthcare. It is time that people know that this is a thing. So I love that it's really opening the door, but it's not exclusive to that, which is one of the things.

And then the second thing I would say is, and I bet every single physical therapist says this is not all about Kegels.

Lauren:

Yes, that's A big one.

Chelsea:

Yeah, people come in and they're like, “But I do my Kegels.” A lot of the time we're talking about more lengthening or attention or coordination of the pelvic floor. But I never get upset that someone knows about a Kegel because they knew something, right? So I love to be able to help educate them, but definitely people think it's a Kegel and that's it.

Lauren:

Right. Which I think is a great kind of segue for people into understanding more about it because they think, "Okay, kegels, my pelvic floor needs to be strong, and then my problems will be fixed." And for a lot of people, tension might be causing those issues and it's more about relaxing and lengthening. So it's so dynamic and to your point, it's like it's good they know something. And I think it often does open up for a broader discussion when people start to talk about that initially and how complex all of that is together and how different things can cause different issues.

Chelsea:

You've talked about with prolapse, a lot of the patients come in and they feel like they can't relax their pelvic floor because they're like if they relax, everything's going to fall out. And no, that's not how it works. Even though that's what our bias wants us to think. We have to hold our muscles to hold everything up. And so it's a lot of education on how we might need to strengthen the pelvic floor, but we kind of have to do a thorough assessment and figure out why and what's going on. We help patients learn to be confident that if they relax their pelvic floor, everything's not going to fall.

Lauren:

Right. I know. Because that's another thing too, that's interesting that I have observed a lot in myself since having prolapse. It's one of those things where it's hard to explain to people when your body is functioning the right way, you don't think about it. You don't think about when moving your arm or walking or doing those things. Whereas once it's not working, that's when it's top of mind and you're having to think about, holding your muscles so things don't fall out. And it is hard to navigate that for sure. It's constantly top of mind and you're trying to live your day-to-day life and figure all these things out at the same time.

Chelsea:

Yeah. You're trying to problem solve something that you didn't even know could possibly exist. Exactly. A lot of people say, "I didn't even know this could happen to me."

Lauren:

Right. I tell some people that one of the biggest ones is when I will go through a day and I don't have to think about it. It goes back to like, okay, I can just walk or carry my kids or do whatever, and I'm not thinking about it. That's a huge win.

 

 

3. Bowel and Bladder Habits for Good Pelvic Health

Lauren:

Are there some general habits that folks should keep in mind for good pelvic health?

Chelsea:

Yeah, I think the first one that all of us could probably be better about, and I don't want to generalize everyone, but I would say most patients I ask this question to, everyone tends to run a little more dehydrated. So the first one is hydration. Hydration has a huge impact on our bladder function, our bowel function, our soft tissue function; they're very reliant on hydration and water. So first, one of my tips is to make sure you're well hydrated. Our bladder can act up, our bowels can act up, and our tissues and muscles have a hard time being efficient if we're dehydrated. Obviously there's some people who crush it. I know a lot of my patients who are currently lactating are really good at slugging down fluids.

 And then just knowing the way we treat and respond to our bladder and our bowels are a little different. So our bladder, we don't always want to necessarily pee every time we think we could pee. So normally we should be able to go back two to three hours without having to pee. If we go more frequently, we might create a habit. So I usually tell a little tip of try to go when you think your bladder is full, but not out of habit.

And then bowels, I tell a lot of my patients, if you get the urge, please go. We don't want to miss the bowel cues. We don't want to cause us not to have cues again the rest of the day. So that's how the bladder and bowels are a little different.

And so for those tips, I would say bladder is we want to really spread it out a little bit. Bowels, when you get the urge, please go. That means your gut's already working and kind of setting the stage for everything to happen.

And in terms of exercise, just having really good mindfulness. If you're able to deep breathe and feel tissues relax. And then when you're trying to connect or contract or get a muscle to respond, just having really good mindfulness can help a lot of patients. It's just knowing that all of our muscles have the ability to lengthen and relax and they all have an ability to shorten. And sometimes just tapping into that mindfulness can be really helpful.

 

4. “The Body is Meant to Heal”: A Traumatic Birth Recovery Story

Lauren:

Can you share a success story with us where you've been able to make a big difference for someone?

Chelsea:

Yeah. So one of my absolute favorite patients, I love all my patients, but this one was a first time mom. She was actually an occupational therapist herself and had nothing to do with the pelvic health field. She came in and was like, "I know some stuff, but I really don't know much." And she had an OASIS tear. During her vaginal birth of her child, she had an obstetric laceration that tore through her perineum and it tore through her anal sphincter as well. And then during her recovery, she ended up having a wound dehiscence, which means that the incision opened up and that's when you can worry about infection and abscess. So she then went on to have a revision surgery.

So she came into physical therapy and she was such a positive person, but she made comments that were like, "Yeah, it's a totally different experience when you're in a diaper. You're literally pooping yourself and your newborn's in a diaper because they are pooping themselves."

And she said, "For some people it's short term, but this has been kind of long term for me because of everything that's happening with the healing." So she did phenomenal. We were able to get her coordination and her strength back. We were able to get the pain down around the scar tissue. We were able to get her bladder functioning really well. She was very active before the pregnancy and during, so we were able to get her back to some physical activity.

But I think one of the coolest days in my career was when she was towards the end of her care, she had gotten back from Mexico, where she had been for a destination wedding. And she was like, "Chelsea, I drank alcohol in a bikini, in a pool, in front of people." She's like, "I didn't pee urine all over myself having bladder irritants. I didn't leak stool anywhere. And I was able to eat and not worry about my bowels or leaking, and I was able to dance and play in the pool and not worry." And at that moment I was like, "This is actually one of the coolest things ever." Her confidence changed. Day one, she came in and she was like, "I'm in a diaper. I can't do anything." And then at the end, she was saying "I was just in a bikini all week and had no concerns and danced at a wedding and didn't leak."

Lauren:

Oh, that's amazing. I love hearing stories like that. I do think, especially in a situation like that, it can feel hopeless and like, "Where is this going to go? Is this my new life? Can I ever feel remotely like myself again?" So hearing things like that is incredible because it really just does shine light on the fact that even from something really hard and a major thing, you can come back from it.

Chelsea:

The body's meant to heal! The body's just amazing.

Lauren:

And I think that reminder is so helpful because in those moments, like that early postpartum stage, you're experiencing all these things, you don't know what's happened to you and you're not feeling like yourself, and then you add on this thing that you didn't even anticipate. And just hearing that the body's meant to heal I think is very, very powerful for people who are in the throes of an experience like that. So thank you.

5. The #1 Tip for Overcoming Hesitation About Pelvic Health Care

Lauren:

If someone is hesitant to seek help or maybe isn't sure, what is something that you would tell them to try to encourage them or make them feel more confident in a decision?

Chelsea:

I haven't met a single someone in the women's health space that isn't kind and empathetic and willing to listen. So if someone's not sure, I think finding a provider in their area that might do a free discovery call or connecting with some providers, even through social media, could be a great way to get a little more information. I think what we don't know causes us a lot of anxiety. So I think most of the phone calls of my patients or future patients, or maybe it might not be a perfect season of life for them right now to start, but of patients who you generally will have a call with, they're really grateful and usually they're like, "Wow, I feel so much better after just a conversation." And it doesn't mean they're going to start now, it doesn't mean they're never going to have physical therapy.

But I think the biggest thing is just talking to someone about pelvic floor physical therapy and discussing what someone's treatment style is. Some patients are really nervous because of past history. Some patients just aren't comfortable with the idea of treatments that involve hands-on care. Some patients just are like, "You can do whatever. I just want you to tell me what we're going to do first." And that's something like every provider I've met in pelvic health is very big on: consent. So explaining, "Here are our options, nothing's mandatory. You ultimately get to decide what we do. Here are my recommendations." And usually just getting more information. Knowledge is power. Patients tend to feel a lot better.

 

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**Medical Disclaimer: This post is intended to provide information and resources only. This post or any of the information contained within should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your qualified healthcare provider with any questions you may have regarding your healthcare, conditions, and recommended treatment.