Podcasts about heba shaheed

This podcast is a commentary and does not contain any copyrighted material of the reference source. We strongly recommend accessing/buying the reference source at the same time. ■Reference Source https://www.ted.com/talks/heba_shaheed_is_it_bad_to_hold_your_pee ■Post on this topic (You can get FREE learning materials!) https://englist.me/73-academic-words-reference-from-heba-shaheed-is-it-bad-to-hold-your-pee-ted-talk/ ■Youtube Video https://youtu.be/T4uZTwNCb6E (All Words) https://youtu.be/6Rdcx-zyrAE (Advanced Words) https://youtu.be/L1D67uENPgE (Quick Look) ■Top Page for Further Materials https://englist.me/ ■SNS (Please follow!)

Women's health physio Heba Shaheed confronts the issues we're too embarrassed to talk about – painful sex, constipation, period pain, bladder leakage and endometriosis. Heba argues that too often treatments, such as pelvic physiotherapy, are overlooked or unknown to women. Yet, they can be life-changing. You can find out more about pelvic conditions at: www.jeanhailes.org.au To find a women's health physio in your area, go to: www.choose.physio And you can follow Heba Shaheed on instagram @thepelvicexpert, or at the www.thepelvicexpert.com Jean Hailes for Women's Health is a national not-for-profit organisation dedicated to the health of all women, girls and gender diverse people. For free, accessible, evidence-based health information visit jeanhailes.org.au

Accidentally weeing when you laugh... a urinary tract infection...a vagina that's painfully tight...these and other problems 'down there' happen to a surprising number of us! In this episode pelvic health physiotherapist Heba Shaheed comes to our aid. She explains the changes that happen to our pelvic floor as a normal part of going through our 40s and 50s, and the wide range of niggles and embarassing problems that can happen as a result. The good news is that with the right help, most of the time these problems can be completely fixed. Find out what you can do in this no-holds-barred episode. Heba Shaheed is a Jean Hailes' Women's Health Week champion. You can find more useful resources about your pelvic floor, bladder and bowel health at the Jean Hailes website here. See omnystudio.com/listener for privacy information.

As some of you may know, I’m doing a lot of work at present to free up my pelvic area from adhesions and tightness caused by pulled fascia and a tight pelvic floor, which in physio speak is a hypertonic pelvic floor. So I thought  this would be a great time to talk about some strategies you can bring into your daily life to help loosen adhesions and a frozen pelvis. Transcript: I’ve talked about adhesions and fascia before, but let’s do a quick recap of what adhesions and fascia are.  So fascia is a thin sheet of tissue made from collagen that sits beneath your skin and holds your organs and muscles in place. It also surrounds all the organs, nerves, blood vessels, etc. Fascia surrounding the body is like a bed sheet, if you pinch it or one end, the rest will wrinkle. So what can happen when we’ve had surgery is that these incisions create puckering and scarring in the fascia, which ends up tightening the fascia and pulling it in other directions. Fascia can also become distorted from inflammation, injuries and muscular problems like pelvic floor dysfunction. Adhesions are a form of scar tissue. They are web-like structures and bands of collagen that grow in response to injury and trauma, to ‘knit’ back together a wounded area and as part of the healing process from infection and inflammation. Collagen strands bond together to protect the damaged area to allow healing to occur in a safe and isolated environment, and if an infection is present, they protect the rest of the body by preventing the spread.  Adhesions occur in nearly all cases of abdominal surgery, the results vary from study to study but one large and long study found that between 55% to 100% of women who had pelvic surgery developed adhesions, and up to 90% of people who had major abdominal surgery - so something like a caesarean - developed adhesions. So, if you’ve had one or more surgeries for endo, it’s very likely that you have some adhesions.  Adhesions can also form from inflammation, which we know occurs in those of us with endo due to the lesions and can occur in those of us with SIBO, because the body sees it as an infection. Again, as you probably know by now, research has shown that up to 80% of us with endo may have SIBO, so this could be an additional cause of your adhesions and frozen pelvis. It’s also worth noting here that adhesions can actually cause SIBO too, because they prevent the normal flow of gut.   So, what can we do about it? Thankfully, there are numerous ways to loosen adhesions and free up a frozen pelvis, and as a result, lower the pain and other challenges associated with them. So let’s dive in to my top 8 strategies. This list isn’t exhaustive by any means, and you don’t need to do them all! Just pick those that feel the most helpful for you and suit your lifestyle and budget.    1. Foam Rolling Number one is foam rolling, which is an effective and affordable at home strategy which you can use every day if you’d like to! With foam rolling, we’re really looking at loosening the fascia rather than working on the adhesions directly. As I said earlier, fascia can get tight, pulled, puckered, and wrinkled, and if it’s experiencing it in one place, it can affect other areas in the body.  Foam rolling helps to release a distorted fascia and is when we literally use a long foam cylinder to roll back and forth across various areas of our body. With foam rolling for endo or other pelvic pain issues, we’re not just rolling back and forth on our pelvis, we’re rolling across our hips, bums, back, upper back and legs.  In the show notes I have linked to videos on how to do this, by physiotherapist Dr. Nicole Cozean. You can order foam rollers from Amazon for about £11 and in the beginning, I would suggest starting gently with a soft roller that’s smooth, especially if you’ve experiencing a lot of pain. Now with all of these methods, listen to your body. Some discomfort is normal when we’re working with releasing facia and adhesions, but if it’s really painful, ease up and go lightly or if it doesn’t feel right at all, appreciate that this may not be the right approach for you at first.  In an ideal world, we’d use these strategies under the guidance of a physiotherapist, but I know that’s not always an affordable option for everyone, so carefully watch the tutorials and if you’d like to do some further research to be really comfortable, I suggest reading Know Your Endo by Jessica Murnane, as she interviews Heba Shaheed, who I’ve had on the podcast before as well, and they talk about foam rolling extensively in the book.   2.   Visceral Manipulation  Next up is visceral manipulation, which honestly, if you can afford it, I really believe is worth a try! Visceral manipulation is a form of organ massage which was designed by physiotherapist Jean-Pierre Barral with the particular intention to free up organs from adhesions and other structural issues that are restricting them. Organs are supposed to be able to expand and move gently as our body moves, and glide smoothly over muscles and nerves as we go about our day. When adhesions or some kind of other structural problem is keeping them stuck, that’s when we can experience pain and organ dysfunction.  Visceral manipulation is very effective for releasing these organs and loosening adhesions and I’ve seen some incredible results with my clients. What I will caution here is that it can feel quite intense and aggressive at times, and if your pelvis is very stuck, you may be better off starting more gently with a different type of massage like some kind of womb massage such as the one I’m going to suggest in the next point.  If you’re going to try visceral manipulation, make sure you’re comfortable with your therapist and be very clear with them about the pain or discomfort you experience within the session, so they know when to ease up or when to stop working on an area if it feels too much. I can tell you from personal experience that gritting your teeth and baring it does not always end well!  Other greats forms of organ/abdominal massage include Mercier Therapy and Clear Passage. Clear Passage is really the holy grail with lots of research behind it for endo and SIBO, but it’s incredibly expensive, so you may be better off trying the other techniques first. However, I do highly recommend it if you can afford it!  I’ve linked in the show notes how to find practitioners for all of these that I’ve just mentioned.   3.  Arvigo Massage Third on our list is Arvigo Therapy, which is a form of abdominal massage that is much more gentle than the ones I just mentioned previously. The benefit of Arvigo Therapy is that you only need one session, which can be done over Zoom, to learn it from a therapist, and then you can just practice it daily at home every evening.  Now in my conversation with Tara Ghosh, who is an Arvigo Therapist and actually taught me personally, she shares that whilst Arvigo Therapy doesn’t directly loosen adhesions like visceral manipulation does, it does encourage circulation to the area and helps to relax the muscles and organs in the area, which can then have the indirect effect of loosening a frozen pelvis. However, I have seen some articles by therapists claiming it can loosen adhesions, perhaps they mean indirectly or perhaps there are differing opinions, but you can listen to the interview with Tara in episode 127 to learn more.  I highly recommend working with Tara because she’s just the loveliest person, and you can reach out to her directly via the details she shared in the interview (and I’ll put her Instagram in the show notes) but if you want to find another therapist, I’ve linked to the directory in the show notes. I’m pretty sure Tara sees clients from all over the world.   4.  Breaking up your time sitting down Number four is all about breaking up the time you spend sitting down at your desk, specifically by using a standing desk and by taking regular breaks.  Now, there’s been a lot of debate and controversy over this in the past few days. You may have seen in my stories I posted about my standing desk, which I use at varying intervals during the day, alternating between sitting and standing. I do this because my own physios and my colleagues, many of who are pelvic floor physios and my pelvic pain training, have always taught me that sitting for long periods of time without a break can worsen pelvic floor dysfunction symptoms through shortening and weaking the muscles in the area and restricting blood flow.  My understanding was that sitting down for long periods of time without breaks shortens the muscles in the front of our hips and pelvis, which means when we stand, walk or do anything else that isn’t sitting, we have restricted movement, tension, tightness and are more likely to experience pain. And if we have adhesions in the area, sitting down for long periods of time lessens the opportunity to stretch them and release them, making their hold on our organs stronger and tighter. However, I had quite an strongly worded message form a physio informing me that this simply isn’t true and that muscles don’t shorten or lengthen, which absolutely threw me. So I went away and spoke to some colleagues and they all said that yes, muscles shorten and that sitting for prolonged periods of time causes this and can worsen pelvic floor issues. So I was quite confused!  I wanted to dig a bit deeper to understand why this physio said they don’t and I think what it boils down to is terminology, and oversimplification to make physio language easy for patients to understand. From what I gather through my own research and conversations is that the muscles don’t actually change length, but they lose their ability to stretch so they become restricted. Here’s how one of the PTs I spoke to put it.  Martha Spalding, Circle of Health Physical Therapy, CA: “Muscle length stays the same so no, they don’t elongate but they can be contracted, weak in both eccentric and concentric contractions, strained, sprained, torn and severed. Ligaments can be overstretched and they can have laxity, which is common during pregnancy and some people just have genetic ligamentous laxity. Prolonged sitting is stressful on the entire spine and pelvic floor as it is a prolonged static position in weight bearing on the pelvis. The pelvis is generally rotated posteriorly. Depending on the muscles, you can determine the stress component in the sitting position. This prolonged position does impact the fascial slings which can become restricted.” So to help understand this better, eccentric contraction means when muscle length increases from tension during a movement, like a stretch. In contrast, concentric contraction is when a muscle shortens and tenses in order to bear weight and counteract resistance, so think about lifting a dumbbell in a bicep curl. So in short, the ability to perform these contractions can become weaker. Laxity is defined as ‘looseness of muscle’, but I wouldn’t say this would be occurring here, it’s just an example she’s providing to demonstrate how muscles change.   After these conversations, the physio who originally contacted me also replied to say that sitting all day without any movement would cause joint and muscle stiffness, but she was also very clear to state that there are no detrimental effects on the pelvis with sitting.  So clearly there are some cross overs here, but also some differing of opinions. As I’m not a physio, I can’t really give you a definite answer so I’m providing you with the information I have gained and also what I have learned in my own time in training and working with physios. To my knowledge, yes, sitting without breaks and movement can have an impact, but I’ll leave it to you to decide.  My practice is to alternate between sitting and standing throughout the day, as I feel comfortable. When I start to feel tired and my legs need a break, I sit down, and when I feel like I’ve been sitting for long enough, I stand. And every 30 minutes to an hour of sitting at my desk working, I get up and do some form of movement, usually it’s a couple of minutes of rebounding, stretching, walking around the house or a few minutes of exercise and literally it’s just like 3 to 5 minutes. Now I appreciate that if you have chronic pelvic pain and a weak core from pelvic floor dysfunction and from living with chronic pain, that using a standing desk can be difficult to do. So I suggest starting when only you’re ready with smaller periods of time to build up the strength in the core and to also have a cushioned mat under your feet or cushioned slippers to soften the impact. If you need to first spend some time just practicing taking breaks with gentle movement to build up your strength, or if you need to do some physio first or work on pain alleviation, do that first. This is just an option and you have to do what feels right for you – don’t rush into using a standing desk just because I’ve talked about it today, make sure it’s the right choice for you.  If you do buy a standing desk, you should also be swapping your positions when you’re standing up, so you’re not just constantly bearing down on your joints. I’ve linked to a helpful article in the show notes on different positions to adopt and how to stand in a healthy way when using a standing desk. There’s now mounting information on the health risks of sitting for long periods of time without breaks or movement, including heightened inflammation, which you guys know is super important for us to keep on top of, so if you’re employed by a company, they really shouldn’t be surprised by you asking for a standing desk. And in fact, it should fall under reasonable adjustments to help make you feel more comfortable when living with endometriosis. If you have trouble getting your company to agree, I suggest having a listen to my interviews with Vickie Williams and Clare from See Her Thrive, which are both about your rights as an employee with endometriosis in the workplace. If you’re curious to learn more about the health considerations and research behind prolonged sitting, I’ve linked to a couple of articles in the show notes. If you’re self-employed like I am, you can easily order a standing desk online. Prices range dramatically from whole desks which adjust to become either a seated or standing desk at about £1000 or cardboard desk toppers that you just put on top of your desk, and that you rest your keyboard and computer or laptop on, and these are around £15.  If you’re not quite ready for a standing desk or you’d like something extra to support your pelvis further when sitting, it’s best to take a quick break from sitting every 30 minutes if possible. I recently spoke to Rachal Dutton, The Period Whisperer, and she suggested getting up and doing hip circles both clockwise and anticlockwise for a minute or so or doing cat cow stretches whilst still in your chair. There are tonnes of movements you can do whilst seated to give your pelvis a quick break, so if you’d like more options, do some extra research until you find some that suit you!  To bring this unusually controversial tip to an end, I want to reassure you that if you need to sit down or lay down regularly, it’s okay. The key really is about trying to add in healthy movement as and when your health allows, and to take frequent short breaks from the sitting position, again as and when your health allows. I understand that there are days when all you can do is stay curled up, I’ve been there too! But on the days when you feel stronger, consider some small movements like rotating your hips or a quick cat cow to break things up a bit.    5.  Pelvic floor stretches You knew I was going to go there. Pelvic floor physio stretches are essential, in my opinion, to loosening adhesions and freeing up a frozen pelvis. Of course, in an ideal world, we’d all go to pelvic floor physiotherapists who can give us tailored stretches to do daily at home, but that’s not an option for some people on smaller incomes. So if that’s you, you’ll be pleased to know that there are so many pelvic floor stretches for endo and chronic pelvic pain available online and in books.  I’ve linked to videos, articles and books in the show notes for you to choose from, and all of these are designed by professional and specialised women’s health pelvic floor physiotherapists. What I will say is to listen to your body here. If you’re experiencing pain, or you have a strong reaction, ease up or try a different stretch – you may be currently too tight or ‘frozen’ in the pelvic area to attempt certain stretches for the time being, so start slower and allow some space and flexibility to build before attempting those pain triggering ones again. You could add these in during your day, as part of your break from sitting, or in the morning as a way to wake your body up, or in the evening to help you to wind down. Whatever it is, find a time that suits you and don’t worry, you don’t have to spend half an hour on this! Ten or even five minutes is fine! Just start and try to get them in as often as possible, daily if you can – but don’t stress if you can’t!  Now of course, I don’t know your personal circumstances, so if stretching isn’t the right choice for you right now, don’t worry, try something else from this list that is.   6.  Proteolytic enzymes  Alright, number six is proteolytic enzymes. Proteolytic enzymes are enzymes which break down proteins into amino acids. Proteolytic enzymes, when used for healing, help to reduce inflammation post-surgery and aid in clearing waste products from the wound site, and help to reduce adhesion formation. This is because of course, the building blocks of tissue are proteins!  However, because they reduce adhesion formation, there is the risk that if there is an infection at the site of the wound, that it could spread, as adhesions play a role in isolating infection sites from the rest of the body. This is rare but has been known to happen. Another thing to note is that the research is limited, with most of the research being in oral surgery or sports related injuries. The only study we have on enzymes for endo specifically is one we use commonly at IWHI and that’s Wobenzyme. Wobenzyme was shown to reduce pain and inflammation post-surgery and inhibit the formation of new blood vessels, reducing the chances of further endo development and adhesion formation.  The dose used in the study was the label dose for 40-60 days pre-op and then 60 days post op. You need to take Wobenzyme away from food, otherwise the enzymes will just be used for digestion.  Now most of the studies on adhesion formation are conducted pre and post-op, so I really can’t say whether they’d make a difference if you surgery was five years ago for example, my instinct is that they wouldn’t aid with the adhesions but they might help with inflammation.    7.  Castor oil  So number seven is castor oil and this one is also a little controversial, so I’ll provide you with the info and you can make your own decision about it.  I know countless leading women’s health practitioners who use castor oil to soften and break down adhesions and who experience great success with it with their clients. However, it’s generally considered that more research needs to be done, though there is research on castor oil’s abilities to lower inflammation, reduce symptoms of constipation, improve circulation, and stimulate muscle relaxation.  You may have heard Arvigo Therapist Tara Ghosh break it down in my interview with her. She explained that castor oil actually triggers the immune system, due to some of its chemical components, however, on responding to the call and finding no poison to clear, the immune system goes about utilising its tools on repairing and healing the pelvic area, which in turn helps to break down and clear adhesions. She also emphasises that the lowering of inflammation and improving of blood flow to the area, thanks to castor oil, is part of how this process works.  She’s not the only fan either. I had a conversation about castor oil with my colleagues and so many of them used castor oil packs to break down adhesions, and Nicole Jardim is a fan of using them for endometriosis and period pain.  So if you want to learn how to make your own castor oil pack and how and when to safely use them, I advise listening to my interview with Tara who has a really quick and easy method as opposed to the often messy and sticky traditional approach!   8.  Heat Therapy Last up is heat therapy. Yet another controversial one.  Heat therapy is often used by practitioners to help loosen fascia, muscles and break down adhesions. I recently spoke to Rachel Dutton who strongly recommended it to me to help with the lower right side of my pelvis, which is really stuck and isn’t responding well to body work therapy because it’s just too frozen and so I need to start with a gentler approach. She explained to me that heat therapy stimulates blood flow, which as a result helps to break down scar tissue and suggested this as one of the first options I should try.  Additionally, increased blood flow will allow the muscles to relax as more oxygen is delivered and so any muscles which were contracting due to restricted access to oxygen, which is common when you have a tight, bunched up pelvis, can start to loosen and become more mobile. There’s also research showing how heat therapy can prevent adhesions from building up so much after injury. Unfortunately PubMed was down at the time of writing this, so I haven’t got a tonne of studies to stick in the show notes but I’ve put in a few articles and one or two studies, and of course you can do some of your own research as well. So now the controversy comes in. Some sources, but not many, claim that heat can loosen adhesions and fascia and then as they cool, they stiffen up again, and become stiffer than before. I dug into this further and honestly, I couldn’t really decipher how they sources came to that conclusion, and I spoke to multiple colleagues about this who were equally as baffled and looked at the articles with me, and didn’t really feel the claims were fully supported.  However, one research paper does discuss the rebound phenomenon, where the positive effects of heat therapy are actually only present for 20-30 minutes. So for 20 to 30 minutes, blood vessel dilate and blood flow increases, but afterwards, the blood vessels actually start to constrict again, preventing blood flow, so this is definitely worth taking into consideration.  After I raised this to my colleagues, they all agreed that they only use heat therapy for 20 to 30 minutes in terms of hot water bottles, normally applied alongside castor oil packs and perhaps alongside a massage therapy treatment. They were also very keen to stress that they never use boiling water in a hot water bottle, only warm water. However, I’m curious about whether we can go a step further than hot water bottles. For a long time now, I’ve been very interested in the research behind infrared therapy, which has been shown to heal muscle injury, tissue damage and lower inflammation. For this reason, I’ve been really curious about infrared sauna belts and infrared heat pads for my chronic bladder pain, because they have so many benefits, but I just haven’t bought one yet as I’m spending so much on SIBO healing. The prices that I have seen range between £50 and £60, so not that expensive, but for some of us a hot water bottle is the more affordable choice.  So whilst I can be sure about the theory that adhesions and muscles get worse after heat therapy, clinically, heat therapy seems to achieve remarkable results, especially when combined with castor oil packs and massage. Of course, if you’re going to use hot water bottles, just keep it to less than 30 minutes and don’t use water straight off the boil. I think a wonderful way to try heat therapy is to use heat 30 minutes prior to a home massage, like Arvigo Therapy, to relax and soften the muscles so they’re more pliable and open to movement and stretch.  So I hope that has given you some ideas to help you soften your fascia, loosen adhesions and release a frozen pelvis. Remember, what works for one may not work for another, always listen to your body and be guided by what it’s telling you and ideally, consult a practitioner if you can afford to do so.  I would love to hear which strategies you try and how you get on! Please remember I am not a physiotherapist or a masseuse. This information comes from my training as a health coach, my conversations and interviews with leading pelvic floor physios and my experiences a patient. This podcast is here for educational purposes only. Let's get social! Come say hello on Instagram or sign up to my newsletter. This episode is sponsored by my free guide ‘A Natural Pain Relief Tool Kit for Endometriosis’. This four page guide includes evidence based and effective remedies which you can use at home to reduce your pain with endo. Download your copy here. My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here. If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at hello@thisendolife.com or visit my website. This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk Show Notes Adhesions https://pubmed.ncbi.nlm.nih.gov/11528133/   Foam Rolling https://www.youtube.com/watch?v=xJOzcFS6fGE https://www.youtube.com/watch?v=umTObqSYay0 https://www.youtube.com/watch?v=V6cR3knKFIA   Visceral Manipulation https://www.iahp.com/pages/search/index.php https://clearpassage.com https://www.merciertherapy.com (You currently need to email them directly for a referral)   Arvigo Therapy https://www.arvigotherapy.com/team-members   Sitting https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/sitting/faq-20058005 https://www.nhs.uk/live-well/exercise/why-sitting-too-much-is-bad-for-us/ https://www.startstanding.org/standing-desks/10-standing-desk-mistakes/#positions   Stretching https://www.youtube.com/channel/UCXigFK5hLLF82uZ72jzTvmg/videos https://www.harpercollins.com/products/beating-endo-iris-kerin-orbuch-mdamy-stein-dpt?variant=32903931691042 https://thepelvicexpert.com/blog/6-simple-exercises-to-ease-endometriosis/   Heat Therapy https://pubmed.ncbi.nlm.nih.gov/31115522/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214933/ https://www.researchgate.net/publication/300270473_Superficial_Heat_and_Cold_Applications_in_the_Treatment_of_Knee_Osteoarthritis   Castor Oil https://nicolejardim.com/castor-oil/      

You’re doing everything ‘right’ yet you’re still having flare ups. Does this sound like you? If so, I think you’ll find this mini episode helpful! Today’s episode is another special episode from my live Q&A calls with my Live and Thrive with Endo Course coaching group. The questions they’ve been asking have been amazing and I know will resonate with many of you, so I decided to share some of my answers to some of the most frequently asked questions. In this episode I’m answering the question ‘Why am I still getting flare ups when I’ve made so many changes to my diet? How much of an impact does diet really have?’ In this episode I discuss: Why we generally begin with diet changes How we can be eating anti-inflammatory foods but still triggering inflammation with imbalanced blood sugar How stress can impact pain signals How infections and gut health can worsen inflammation in the body Why it’s important to explore pelvic floor health and adhesions when healing endo Other factors to check in with such as sleep ands lack of exercise. Let's get social! Come say hello on Instagram or sign up to my newsletter. This episode is sponsored by my free guide ‘A Natural Pain Relief Tool Kit for Endometriosis’. This four page guide includes evidence based and effective remedies which you can use at home to reduce your pain with endo. Download your copy here. My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here. If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at hello@thisendolife.com or visit my website. This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk Show Notes Useful podcast episodes to listen to if you’re still having pain after diet changes - Can Stress or Trauma Trigger the Onset of Endometriosis? 9 Root Causes of Painful Sex with Endometriosis Your Brain on Pain - How Your Nervous System Affects Interstitial Cystitis and Endo Pain with Dr. Nicole Cozean The SIBO, Endometriosis and Interstitial Cystitis Connection wth Dr. Allison Siebecker Anti-inflammatory Living for Endometriosis Pelvic Floor Therapy for Endometriosis with Heba Shaheed of The Pelvic Expert

I wanted to do an episode on the back of my 9 Root Causes of Painful Sex with Endometriosis episode, as I talk about bloating, bladder pain, brain fog and fatigue a lot, but I haven’t covered painful sex much lately.  This episode contains a range of strategies, some long-term, some more short-term and this list certainly isn’t exhaustive. Many of the changes you make to improve your endometriosis in general, such as healing the gut, are not covered here but will certainly make a difference to the pain you feel during sex. You don’t have to try all of these and you certainly don’t have to try them all at the same time, but see which ones resonate for you. TRIGGER WARNING: This podcast contains brief references to sexual trauma.  Reduce chronic inflammation - Nutrition is one of the most effective ways to reduce inflammation. Foods that cause inflammation include sugar, alcohol, trans fats, processed conventional meats, processed foods and for some; gluten, dairy and caffeine, as well as other foods groups you may personally be sensitive to, even if they seem healthy (eggs, nightshades, etc.). A four-week elimination diet is one of the best ways to identify what personally inflames your body and causes irritation. You remove certain foods for this period of time and then return them to your diet one by one and look for symptoms. This is best done with the support of a health practitioner or at least following a protocol from a patient book or course. If a full-on elimination diet feels daunting of triggering to you, a smaller version where you just remove some of the key inflammatories like sugar, may be more doable. Regardless of your choice, filling your diet with anti-inflammatory foods will be incredibly beneficial - aiming for 8 servings of veggies, 2 portions of fruit, healthy fats, organic clean proteins and gluten free wholegrains (as long as you’re not sensitive to them). Balancing blood sugar is also key to lowering inflammation. Some of the basics of balancing blood sugar are keeping refined carbs and simple sugars to special occasions and ensuring you have a plate ratio of 50% low starch veggies, 25% protein and the final 25% split between healthy fats and complex carbohydrates. Pelvic floor physiotherapy - Arguably one of the most important when it comes to healing painful sex! Pelvic floor physiotherapy can release the tension and tightness in the muscles and ease nerve sensitivity in the area, as well as relaxing the vaginal canal. You want to look for a pelvic floor physio specifically - not just any physio - and one who is familiar with endo and pelvic pain conditions. Don’t worry, they won’t go internal straight away if you’re uncomfortable, but if you’re willing, they’ll do an internal examination in the first session to identify what’s happening. If not, they’ll work externally to reduce your pain until you feel ready for an external examination. If you can’t afford a physiotherapist, there are courses, free videos and paid for videos which are all incredible resources and are linked below. The Ohnut - The Ohnut is a wearable non-toxic rubber-like ring which stacks on to the penis or whatever form of penetration you’re using and allows you to control penetration depth. The tool comes with several rings so you can customise depth to your comfort. The tool was designed by Emily Sauer who has suffered with painful sex for years and designed the product in her kitchen!  It has changed the sex lives of countless people with painful sex and partners enjoy it too! Swap perfumed and toxic products for non-toxic, vagina friendly products (and get some lube!) - Did you know that the chemicals and perfumes found in everyday body products can cause reproductive health issues, fertility problems and hormonal imbalances, and have been directly linked to endometriosis? These products can also irritate the skin and inflame the sensitive vaginal area, which is made of very absorbent tissue. Instead, try swapping to organic and non-toxic based products that are perfume free and suitable for the vagina and sensitive skin, especially focus on your period products, wipes if you use them, body wash and most definitely, lubricant!  I’ve linked to some of my favourite products below. Don’t rush and jump into penetration before you’re ready - If your body isn’t ready for sex and well lubricated, whether naturally or with lubricant, the friction of sex may cause tiny tears in the vaginal wall, leading to irritation, swelling and inflammation. Equally, if you’re not ready your vagina may not be open and relaxed enough, and therefore may more easily tense up and experience pain upon penetration. Help your brain to feel safe - This isn’t something you have to do during or before sex, but more generally on a daily basis, is to help the brain feel safe by flooding it with safety signals. When we have an upregulated nervous system, it can be hard to tell the brain to quiet those danger signals, so the aim is to calm the brain down by reassuring it with safety signals instead. We want to train the brain to move out of flight or fight and spend more time in the rest and digest mode, by repeatedly lowering cortisol. Proven methods of lowering cortisol include connecting with your own support network, walking in nature, yoga, breathwork and meditation. Self-massage (potentially using a yoni wand) - You can use self-massage to identify your pain points (known as triggers) in your vaginal canal and use massage to ease tension and release these tighter areas. If you’re not comfortable with using your hands, you could use a tool called a yoni wand, which you can insert into the vagina and move in a clockwise manner to ‘map’ the pain points within your vagina, and then carefully use massage to release these. This is best done following instructions, which I’ve linked to below in the show notes. Identify and work on tensions in your relationship - Do you feel comfortable in your relationship? Do you feel pressured or guilty about sex, or have you not really been able to share how you feel during sex? Does your partner not support you around endo, or are there other tensions unrelated to endo that need to be addressed? This is an area that can take a long time to work on and explore but can make a huge difference. If there are tensions in your relationship, this will put your brain in flight or fight mode and signal to your body that it’s not safe, potentially creating tensing and pain during sex. Couples therapy could be an option for those who are ready, but even listening to podcasts or reading books on healthy relationships can help, or even just having a difficult conversation. Address trauma and any discomfort around sexuality - If you’ve experienced sexual trauma, you may likely benefit from some kind of therapy that helps you to process that trauma. There are various types of therapy for trauma from EDMR to Somatic Experiencing. If you’re not ready for talking, there are a number of books, podcasts and resources available online to help you begin the process. If you haven’t experienced trauma but you’re uncomfortable with your sexuality or sex in general for whatever reason, therapy could also be helpful, as could reading books, taking courses and workshops and listening to podcasts on sexuality.  I’ve linked to resources for both below. Visceral manipulation - Visceral manipulation can help free up the pelvis and organs that have become ‘frozen’ from scar tissue and adhesions. Clear Passage has lots of research behind it and is one of the most effective for pelvic pain, endometriosis, SIBO and infertility, but is expensive. Another wonderful option is Mercier Therapy, which is specifically designed for gynaecological conditions and pelvic pain, but you can also find general visceral manipulation therapists too! A good pelvic floor physiotherapist may also be able to do visceral manipulation on adhesions as well. For more info on where to find these support resources, scroll down to the show notes. Listen and subscribe on iTunes, Stitcher, listen directly/download MP3 here or just listen below! Let's get social! Come say hello on Instagram, Twitter and Facebook or sign up to my newsletter. This episode is sponsored by my free guide ‘A Natural Pain Relief Tool Kit for Endometriosis’. This four page guide includes evidence based and effective remedies which you can use at home to reduce your pain with endo. Download your copy here. My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here. If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at hello@thisendolife.com or visit my website. This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk This episode is sponsored by Semaine Health, the anti-inflammatory, plant-based pain relieving supplement. Now priced at $28.99 for subscription. Shop here. Show Notes Reduce chronic inflammation Outsmart Endometriosis: The Elimination 'Undiet' for Endometriosis with Dr Jessica Drummond Antioxidants for Endometriosis Anti-inflammatory Living for Endometriosis What is The Endometriosis Diet with Henrietta Norton of Wild Nutrition Six Tips for Reducing Endometriosis Pain in The Week Before Your Period Reduce Fatigue, Endometriosis Symptoms and Oestrogen Dominance with A Better Breakfast Pelvic Floor Physiotherapy Equal Treatment for Black Endometriosis Patients and Pelvic Floor Physiotherapy for Painful Sex, Interstitial Cystitis and Endometriosis with Dr. Juan Michelle Martin Your Brain on Pain - How Your Nervous System Affects Interstitial Cystitis and Endo Pain with Dr. Nicole Cozean Pelvic Floor Therapy for Endometriosis with Heba Shaheed of The Pelvic Expert Yoga for Endometriosis Yoga for Vulvodynia Relieving Pelvic Pain yoga video Pelvic Sanity You Tube Ohnut Ohnut website How Ohnut is Easing Painful Sex with Emily Sauer Non-toxic products Yes Yes Yes Into the Wylde Foria Wellness Womanology Urtekram SIMS Headspace Yoga for Endometriosis Yoga for Vulvodynia Relieving Pelvic Pain yoga video Frequency breath work Self-massage Healing Endometriosis-Associated Dyspareunia and Rediscovering Pleasure with Elena of The Yoni Empire Yoni mapping blog post Yoni massage blog post CURVE yoni mapping toy Healing Endometriosis-Associated Dyspareunia and Rediscovering Pleasure with Elena of The Yoni Empire Relationships Communication, Relationships and Endometriosis with Melanie Cox Relate How We Cope with Endometriosis as a Couple - A Conversation with My Boyfriend The Gottman Institute for relationships The Zim-Zum of Love Addressing trauma and getting comfortable with your sexuality Mind charity EDMR therapy Trauma Recovery + The Epigenetics Of Stress + Rewiring The Survival Brain With Elizabeth Stanley, PhD The Sex Doctor Come as You Are: The Surprising New Science That Will Transform Your Sex Life OMG Yes Eat. Play.Sex. Podcast Visceral Manipulation Mercier Therapy for Pelvic Related Conditions with Dr. Jennifer Mercier The Healthy Gut Podcast Ep.25: Adhesions And SIBO With Larry And Belinda Wurn The Healthy Gut Podcast Ep.33: Visceral Mobilisation With Alyssa Tait Visceral manipulation practitioner directory  

Today’s episode is another in the root causes series and I’m talking about the root causes of painful sex with endometriosis. 92% of you voted for this episode, so I’m assuming that if you voted, you likely struggle with this symptom. But having painful sex isn’t just part and parcel of having endometriosis - there are things that can be done, and it begins with identifying why you’re experiencing pain in the first place. Endo is complex and the stress it puts on the body can lead to other conditions and complications developing, so we’re going to explore some of these here. If you can begin identifying even just one root cause, the road ahead to healing pain will become clearer.  Again, this is about shining a light on the root causes so you’re no longer in the dark about your health. You don’t have to deal with them all and it’s unlikely you’ll have them all, just begin with one area and take baby steps there.  As I’ve mentioned with all these episodes, this list isn’t exhaustive, but it does include some of the most common conditions associated with painful sex and associated with endometriosis. TRIGGER warning: This episode briefly discusses sexual trauma. Vulvodynia - Vulvodynia is a condition of chronic pain in the vulva area, that is usually worsened by sitting, sex, going to the toilet and movement. You may not have the pain all the time, but it is reoccurring, though some can experience the pain constantly. Many report the pain as a burning/stinging/itching/aching/throbbing sensation. Causes can include untreated or resistant infections like candida, nerve hypersensitivity, damage or trauma to the area, pelvic floor dysfunction and chronic inflammation. In the case of developing vulvodynia with endometriosis, I would argue that the amount of inflammation and an upregulated nervous system from years of chronic pain could in time affect the vulva area, as well as having a tight pelvic floor, which is common with endo patients. Vaginismus - Vaginismus is a condition where the vaginal canal involuntarily spasms and closes, usually in response to some kind of penetration, though I’ve spoken to many people with vaginismus and they report this spasming to eventually happen all the time. This is thought to occur as the body’s response to fear of penetration, even if you don’t mentally feel scared. Vaginismus can be caused by multiple issues. It could be that endo has created so much pain internally that your body now has a fear of sex hurting and so essentially closes up shop. Constant painful, traumatic, invasive and embarrassing medical examinations that you may have endured whilst trying to get an endo diagnosis, or following one, may have triggered the onset of vaginismus as well. Uncomfortable or distressing feelings about sex like shame, guilt or trauma can also cause the condition too. Adhesions or distorted fascia - Adhesions are web like scar tissue structures that do not show up on scans as they’re made of collagen. They grow in response to a wound or trauma and attempt to ‘knit’ an area back together, but can often continue to grow and extend, attaching to organs, wrapping around organs and sticking to surfaces. Adhesions are VERY strong and will cause pain and discomfort, and can pull and tug on organs, restricting their movement and even function. Fascia is a thin sheet of tissue which covers the entire body, sits below the skin and encases the muscles, bones and organs. Endo can grow on the fascia and cause puckering in the surface of it, and excisions form surgery can also cause the fascia to pucker from scar tissue. This puckering pulls the fascia out of shape and can distort the fascia across the rest of the body - think of what happens when you pinch a nice neat bed sheet. If you have adhesions or your fascia is tight and distorted, this could result in painful sex. There may be pulling on your vagina or uterus, they may be putting pressure or causing pain on surrounding organs, which could then impact sex as the organs in the pelvic area are so closely packed together. Don’t forget, your bladder sits in front of your uterus and vaginal canal and your bowel sits directly behind. If any of these are tethered to each other and/or the pelvic wall, this could cause a lot of tension, tugging and pain during sex. Pelvic Floor Dysfunction - Many people with endometriosis have a tight pelvic floor. Think of your pelvic floor as a bowl made of nerves and muscle and in the bowl sits your bladder, vagina and uterus, and colon. These muscles and nerves help to control the function and sensitivity of these organs. When you live in chronic pain due to endo, these nerves in the pelvis get used to sending out distress signals and receiving pain signals, and over time, the nervous system becomes upregulated and this path of distress becomes the default option for your nerves. They become easily triggered, even by something that wouldn’t normally cause pain. Equally, as your muscles continuously react to chronic pain, they begin to tighten. This tightening occurs to both protect you but also as a result of the positions we often adopt when we’re in pain, like curling into a ball. The tightness causes tension, irritates the nerves and distorts the way the organs are sitting and functioning. Vaginitis - Vaginitis is a sort of blanket term for inflammation and irritation caused by, most commonly, some kind of infection. Symptoms include swelling, itchiness, pain and sometimes unusual discharge or some bleeding. Vaginitis isn’t common within the endo population specifically, but it is common in general. Causes include STIs, candida overgrowth, allergic responses to chemicals in contraception, lubricants, body washes, etc., and changes in hormones.  Endo lesions - Endo lesions cause pain, swelling and scar tissue on both the surface their attached to and the surrounding area, and can cause cramping as they shed with the hormone cycle. Endo lesions can be found on the bowel, pouch of Douglas (between the uterus and the bowel) and bladder, amongst of course other areas such as the pelvic cavity and ovaries. These are all very close to vaginal canal, especially if the endo is in the pouch of Douglas, as penetration may be almost directly irritating these endo lesions.  Chronic inflammation - Endo is an inflammatory disease. It creates its own inflammation, it uses inflammatory chemicals in its development and growth, and it triggers the immune system to send inflammation to the area. Inflammation causes pain and swelling, and as the endo lesions are chronic, this swelling and pain can spread throughout the pelvis as the body attempts to get our attention. Meaning that even if you’re vaginal canal or surrounding area isn’t directly being affected by endo, you may experience pain there. IBS - Many people with endo experience IBS like symptoms, which can include bloating, gas, constipation and diarrhea. All of these can make the abdomen and pelvic area tight, swollen, painful and uncomfortable. Your intestines sit right above your uterus and your colon is right behind the vagina and uterus, so if your intestines are inflamed and swollen, the chances are that these are going to be putting pressure on surrounding organs and the inflammation and pain signals will also likely spread to these as well. Equally, IBS problems cause leaky gut. Leaky gut allows allergens and particles to flow through the gut barrier, causing an immune reaction which releases inflammation into the body. Toxins from infections and problems like SIBO can also pass through the barrier and end up in the pelvic cavity, creating further inflammation.  Upregulated nervous system - The brain is designed to protect us from threats. If you have experienced chronic pain, this may have created a loop where the nerves are signalling distress signals to the brain, which then registers with pain to alert us to the problem, inflammation is released but the endo lesions don’t heal, so more distress signals are released and so on. Eventually, over time, this becomes your nervous system’s default pattern - it associates the pelvic areas with danger. This is made worse if you’re experiencing chronic stress or acute moments of stress, if you feel unsafe in your body, your home or with your sexual partner. This stress is telling the brain it’s right to feel unsafe and the danger signals are heightened.  Of course, if you’ve experienced sexual trauma this is likely to have had an impact on your brain’s perception of safety in your pelvis and pain may be the brain’s way of alerting you to that trauma, whether past or present. Scroll to my show notes to learn more about diagnosing these conditions or getting help identifying these issues, and for references and further reading/listening. Listen and subscribe on iTunes, Stitcher, listen directly/download MP3 here or just listen below! Let's get social! Come say hello on Instagram, Twitter and Facebook or sign up to my newsletter. This episode is sponsored by my free guide ‘A Natural Pain Relief Tool Kit for Endometriosis’. This four page guide includes evidence based and effective remedies which you can use at home to reduce your pain with endo. Download your copy here. My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here. If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at hello@thisendolife.com or visit my website. This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk This episode is sponsored by Semaine Health, the anti-inflammatory, plant-based pain relieving supplement. Now priced at $28.99 for subscription. Shop here. Show Notes Vulvodynia National Vulvodynia Association Functional Nutrition Treatment of Vulvodynia, Irritable Bowel Syndrome, and Depression: A Case Report NHS vulvodynia page An Integrative Approach to Healing Vulvodynia w/Hannah Matluck of the V Hive The Changing Landscape of Sexual Health In Medicine w/Dr. Heather Quaile Vaginismus Vaginismus And The Overlaps Between Pelvic Pain Conditions With Shelby Hadden of Tightly Wound Self-Love And Reclaiming Womanhood With Oliwia Drzymuchowska Of Womanology The Vaginismus Network NHS vaginismus Adhesions and distorted fascia The Healthy Gut Podcast Ep.25: Adhesions And SIBO With Larry And Belinda Wurn The Healthy Gut Podcast Ep.33: Visceral Mobilisation With Alyssa Tait The Period Party Podcast: Mercier Therapy for Conditions with Dr. Jennifer Mercier The Best Surgery for Endometriosis with Dr. Andrew Cook Pelvic Floor Dysfunction Equal Treatment for Black Endometriosis Patients and Pelvic Floor Physiotherapy for Painful Sex, Interstitial Cystitis and Endometriosis with Dr. Juan Michelle Martin Your Brain on Pain - How Your Nervous System Affects Interstitial Cystitis and Endo Pain with Dr. Nicole Cozean Pelvic Floor Therapy for Endometriosis with Heba Shaheed of The Pelvic Expert Vaginitis NHS vaginitis Endo lesions The Best Surgery for Endometriosis with Dr. Andrew Cook Six Tips for Reducing Endometriosis Pain in The Week Before Your Period Inflammation Outsmart Endometriosis: The Elimination 'Undiet' for Endometriosis with Dr Jessica Drummond Antioxidants for Endometriosis Anti-inflammatory Living for Endometriosis What is The Endometriosis Diet with Henrietta Norton of Wild Nutrition IBS Dr. Ruscio How To Heal Leaky Gut Understanding The Endometriosis Belly, Part 1 Understanding The Endometriosis Belly, Part 2 Understanding The Endometriosis Belly, Part 3: SIBO Symptoms “Leaky Gut” and Pelvic Pain Dr. Jessica Drummond The SIBO, Endometriosis and Interstitial Cystitis Connection wth Dr. Allison Siebecker How To Treat SIBO with Dr Allison Siebecker How Do You Know When to Test for SIBO? How to Test for SIBO at Home Upregulated Nervous System Your Brain on Pain - How Your Nervous System Affects Interstitial Cystitis and Endo Pain with Dr. Nicole Cozean Taking An Integrative Approach to Endometriosis with Jessica Drummond of The IWHI Anti-inflammatory Living for Endometriosis Healing Endometriosis-Associated Dyspareunia and Rediscovering Pleasure with Elena of The Yoni Empire Communication, Relationships and Endometriosis with Melanie Cox Endometriosis and Energy Healing with Aubree Deimler of Peace with Endo

1.    Endometriosis on the bladder - If you have endo lesions on the bladder or infiltrating the bladder, these will be causing scar tissue, inflammation and irritation to the surrounding area, especially during menstruation when this tissue begins to shed. This inflammation causes pain as the body attempts to alert us of a threat (endo), but as our immune system is unable to ‘clean up’ the endo, the body continues to inflame the area and continues to send pain signals. 2.    Chronic inflammation - Inflammation can spread from one area in the pelvis to another over time, especially if the immune system is unable to clean up whatever is causing the threat. If endo is causing inflammation elsewhere in the pelvis and has done for some time, the inflammation and pain can spread as the nerves and surrounding tissue begin to get involved in the ‘alarm’ process. Inflammation can also come from an inflammatory diet such as a diet rich in trans fats, sugar, processed foods and meat, and alcohol. It can also come from chronic low-lying infections, like an undiagnosed or treatment resistant UTI. Additionally, it can stem from blood sugar dysregulation. Finally, it can also come from your gut. 70%-80% of your immune system lives in and around the gut and if you have a problem like undetected allergies, SIBO, etc., these can lead to leaky gut. Leaky gut occurs when the tight junctions in between the cells of your gut wall begin to open up and allow small food particles and bacteria to pass through. Your immune system and blood stream are sitting just on the other side of your gut wall, and so the immune system attacks these new ‘invaders’ creating an inflammatory reaction, which spreads throughout the body via the blood stream. The toxins release from SIBO and bad bacteria in the gut, can also leak through the leaky gut wall and into the pelvic cavity, creating localised inflammation. 3.    Small intestine bacterial overgrowth - Interstitial cystitis or at least IC symptoms have long been associated with SIBO, especially hydrogen sulphide type SIBO. This will most likely be in part due to the inflammation caused by SIBO, the toxins previously mentioned entering the pelvic cavity and histamine intolerance, which is often caused as a result of SIBO.  However, research has also recently found that some of the key bacteria behind hydrogen sulphide type SIBO are also the same bacteria responsible for chronic UTIS, including Citrobacter, klebsiella, proteus and e-coli. This means that certain UTI treatments may also be effective for H2S SIBO and is currently being explored! 4.    Pelvic Floor Dysfunction - Your pelvic floor is like a complex bowl of nerves and muscles, which holds the bladder, vagina/uterus and colon. These nerves and muscles help to control bladder function and sensitivity. Chronic pain, straining, tensing and pushing can cause the muscles to tighten and lock and the nerves to become hypersensitive This can cause sensitivity, pain and bladder dysfunction over time.  5.    Histamines and oxalate sensitivity - Oxalates are a natural compound found in food. If we’re consuming too many oxalates or our body has trouble breaking them down, we may end up with crystal like particles in our bladder, which can of course cause irritation.  Histamines can also be a problem. Research has shown that some patients with IC have higher levels of mast cells (the cells that release histamines) and histamines in the bladder, and we also know that endometriosis lesions contain higher levels of mast cells too. Additionally, we may have trouble breaking down and clearing histamines if our gut is compromised. We may also be making more histamines if we have excess oestrogen as oestrogen triggers the production of histamines, and a condition called Mast Cell Activation Syndrome also causes mast cells to be over-sensitive and produce too much histamine as well.  Having too much histamine in our body can result in bladder pain, as well as symptoms like nausea, dizziness, rushing heart, racing heart, vomiting and bloating to name a few. 6.    Upregulated nervous system - Your brain’s primary function is to keep you safe and alive - it’s constantly looking for threats, which are communicated to us via our nerves. The body has a scale that measures the threat level and whether it’s worth sending a signal to the brain and if that threshold is met, a distress signal is sent out and the body responds with pain and inflammation to alert us to a problem and to heal the area.  If the wound heals, the brain can calm down, but if it doesn't, as is the case with endo, the nervous system begins a feedback loop of distress, pain and inflammation, which tells the brain things are unsafe, worsening the brains reaction. This can occur if there is endo on or near the bladder. Over time, the brain will actually decrease the body’s natural pain-relieving hormones because it wants us to stay alert as it feels so at threat, and so we begin to become even more sensitive to pain Additionally, anything that puts the brain in flight or fight mode such as stress, fear, anxiety or rushing, will reinforce to the brain that you’re unsafe, and will further heighten the reactions. In fact, research has shown that people with interstitial cystitis tend to have an upregulated nervous system.  7.    Hunner’s lesions - Hunner's lesions are blisters or ulcers inside the bladder that occur in about 10% of people with interstitial cystitis and are of course aggravated by food, drink and other substances. They can be diagnosed with a cystoscopy and can be removed, but often return within a year and though relief is reportedly high, it’s temporary and worth considering whether scarring could occur afterwards. 8.    Biofilms - Biofilms are when a colony of bacteria, viruses and other pathogens get together to form a network, and then hide themselves under a mucosal type lining that protects them from the immune system and antibiotics. They tend to cling to bladder walls and will resist treatment and not show up in standard UTI testing. Specialist testing and the use of anti-biofilms can be effective in treating and eradicating them. 9.    Adhesions - Adhesions are web like scar tissue structures, made up of collagen, which do not show up in scans. Adhesions occur in response to surgery, trauma or wounds and are the body’s natural attempt to ‘knit’ an area back together.  However, adhesions often don’t stop with the wound, and begin to knit towards other scars, organs and surfaces, locking organs together and creating a ‘frozen’ pelvis. In endo, adhesions can grow as a result of surgery and of the lesions themselves. They can pull on the bladder and prevent it from functioning properly, from filling to full capacity and can heighten pain and sensitivity. Adhesions are VERY strong.  10. Chronic UTIs - Due to antibiotic resistance or perhaps the use of the incorrect antibiotics, some UTIs can evade treatment and can burrow into the lining of the bladder to protect themselves, which prevents them from being destroyed by any further treatment. As the bladder wall sheds, bacteria can then move to the surface of the bladder wall again and cause irritation once more - this may be why your UTI symptoms come and go.  Standard tests only identify a small number of UTI bacteria and can also be inaccurate. You can ask for more extensive tests or go private for specialist testing that can help identify chronic UTIs.  Have a listen of the full episode to hear more and to learn the methods of identifying these root causes and scroll down for references. Let's get social! Come say hello on Instagram, Twitter and Facebook or sign up to my newsletter. This episode is sponsored by my free guide ‘A Natural Pain Relief Tool Kit for Endometriosis’. This four page guide includes evidence based and effective remedies which you can use at home to reduce your pain with endo. Download your copy here. My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here. If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at hello@thisendolife.com or visit my website. This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk This episode is sponsored by Semaine Health, the anti-inflammatory, plant-based pain relieving supplement. Now priced at $28.99 for subscription. Shop here. Show Notes Endo on the bladder Six Tips for Reducing Endometriosis Pain in The Week Before Your Period Inflammation Outsmart Endometriosis: The Elimination 'Undiet' for Endometriosis with Dr Jessica Drummond Antioxidants for Endometriosis Anti-inflammatory Living for Endometriosis SIBO Understanding The Endometriosis Belly, Part 3: SIBO Symptoms The SIBO, Endometriosis and Interstitial Cystitis Connection wth Dr. Allison Siebecker How To Treat SIBO with Dr Allison Siebecker How to Test for SIBO Pelvic Floor Dysfunction Equal Treatment for Black Endometriosis Patients and Pelvic Floor Physiotherapy for Painful Sex, Interstitial Cystitis and Endometriosis with Dr. Juan Michelle Martin Your Brain on Pain - How Your Nervous System Affects Interstitial Cystitis and Endo Pain with Dr. Nicole Cozean Pelvic Floor Therapy for Endometriosis with Heba Shaheed of The Pelvic Expert Histamines and oxalates Nutrition for Bladder Pain and Endometriosis with Brianne Thornton, MS, RD of IC Wellness Endometriosis, SIBO, Interstitial Cystitis and Allergies: The Histamine Connection The Association Between Endometriosis and Allergies Diet and Natural Treatment Options for Interstitial Cystitis and Bladder Pain with Elisabeth Yaotani of IC Wellness Interstitial Cystitis and the Histamine Connection Upregulated Nervous System Your Brain on Pain - How Your Nervous System Affects Interstitial Cystitis and Endo Pain with Dr. Nicole Cozean Taking An Integrative Approach to Endometriosis with Jessica Drummond of The IWHI Anti-inflammatory Living for Endometriosis Hunner’s Lesions Hunner's Ulcers - Interstitial Cystitis Association Biofilms Are Biofilms the Root Cause of Your Interstitial Cystitis? With Dr. Deanna Berman, ND, LM Biofilms: Another Potential Contributor to Interstitial Cystitis Biofilm Disruptors - do not take without consulting a practitioner first! Adhesions The Healthy Gut Podcast Ep.25: Adhesions And SIBO With Larry And Belinda Wurn The Healthy Gut Podcast Ep.33: Visceral Mobilisation With Alyssa Tait The Period Party Podcast: Mercier Therapy for Pelvic Related Conditions with Dr. Jennifer Mercier The Best Surgery for Endometriosis with Dr. Andrew Cook Chronic UTIs Interstitial Cystitis Treatment With Ruth Kriz Treating Chronic UTI's with Rochelle Stern

WE DIVE INTO the topic of Chronic Pelvic and Sexual Pain. WE GO DEEP with Pelvic Floor Physiotherapist Heba Shaheed. Heba OPENS UP about the causes of pelvic and sexual pain and how a pelvic floor physiotherapist can help. What are some common causes of chronic pelvic pain and painful sex? How does a pelvic floor physiotherapist assess a woman with these issues? We talk about how special gadgets and sex toys can help manage pain. How can drinking red wine cause clitoral pain? How tight are your vaginal muscles? Maybe too tight and causing you pain? We talk Endometriosis and Interstitial Cystitis otherwise known as bladder pain syndrome… Men also experience pelvic floor pain. We talk on these topics and a whole lot more. Connect with Heba Shaheed:Heba has a blog and online courses at thepelvicexpert.com Instagram: @thepelvicexpert Connect with The Fanny Mechanic: Email : info@drandreadis.com.au Website: www.drandreadis.com.au Website: www.thefannymechanic.com Instagram: dr_tash_the_fanny_mechanic Facebook: Dr Tash Facebook group : The Fanny Mechanic Podcast Group Facebook : Dr Tash Book ClubSupport the show: https://www.thefannymechanic.com/See omnystudio.com/listener for privacy information.

Tahnee welcomes Heba Shaheed to the Women's Series today. Heba is a qualified women's health nutritionist and physiotherapist who specialises in pelvic and sexual pain, menstrual health, bladder and bowel health, pregnancy, postpartum, and complex trauma. Heba provides women’s health and paediatric pelvic health services including physiotherapy, exercise and nutrition. Heba’s mission is to make women's health information accessible globally and to provide high-quality women's healthcare in the privacy and comfort of a woman's own home. Heba believes women's healthcare needs to be disrupted so that women can stop suffering in silence. Heba is a global leader in her field and an absolute wealth of knowledge. Today's chat is informative and truly inspiring, if you're a woman or know one - tune in!   Tahnee and Heba discuss: The anatomy and physiology of the pelvic floor. The normalisation of period pain. What healthy bowel and urinary movements should look like. Mechanical constipation. The functionality of the squat. The pelvic floor and child birth. The use of Jade eggs - best and worst practice. The East vs West approach to pelvic floor therapy. Releasing trauma from the psoas. Multidimensional health and the importance of taking an integrated approach, heart, mind, body.  How and where the body stores emotion.  The subjective nature of pain. Retraining the brain and neuroplasticity. The correlation between pelvic pain conditions and childhood trauma. Sensitivity, self awareness and the importance of developing emotional boundaries. Tips for creating a happy and healthy pelvic floor.   Who is Heba Shaheed ?  Heba Shaheed is co-founder and CEO of The Pelvic Expert, a digital wellbeing platform specialising in maternal, menstrual and hormone health. Heba was inspired to work in this space following her own challenges with a 15-year history of chronic pelvic pain and endometriosis, and after witnessing the devastating effects of birth injury following her sister's first birth. Through the The Pelvic Expert Heba provides holistic and research-based, women-focussed, online wellbeing programs to corporates, government, private health insurers, workplaces and individuals. A qualified physiotherapist, Heba has supported more than 2000 women on their journey to better health and wellbeing, and instructed more than 1200 therapeutic yoga and Pilates exercise classes.  Heba is a leading authority on women’s pelvic health and is a media commentator on this important yet under-represented issue, and a regular speaker at global health and women’s conferences. Heba also offers specialised physiotherapy for complex female pain and endometriosis in her private practice.     Resources:   Heba Website The Pelvic Expert Website The Pelvic Expert Instagram The Pelvic Expert Facebook The Pelvic Expert Youtube The Pelvic Floor Program - Paid 4 Week Course   Q: How Can I Support The SuperFeast Podcast?   A: Tell all your friends and family and share online! We’d also love it if you could subscribe and review this podcast on iTunes. Or  check us out on Stitcher :)! Plus  we're on Spotify!   Check Out The Transcript Here:   Tahnee:   (00:01) Hi everybody, and welcome to the SuperFeast podcast. Today, I am here with Heba Saheed, and she's a qualified women's health nutritionist and physiotherapist. Her expertise lies in pelvic and sexual pain, menstrual health, bladder and bowel health, pregnancy, postpartum and complex trauma. And a lot of that is as you guys know, a massive area of interest for us at SuperFeast. So I'm really excited to have her here today.   Tahnee:  (00:27) She offers one-on-one pelvic health physiotherapy consultations in the Sydney CBD area. And this is for complex pain conditions like endometriosis, bladder pain symptoms, chronic constipation. I may not do these words justice, but I'm going to try, vaginismus and vulvodynia and painful sex, you can laugh at my pronunciation Heba. And she's also the founder of The Pelvic Expert where she blogs about pelvic health and provides online pelvic health programs and consultations which especially right now, given that everyone's in lockdown, is really useful for people.   Tahnee:  (01:01) She has also got a really great Instagram account with is how I came across Heba. It's @thepelvicexpert but we'll put a link to that in the show notes as well. And she also has a really awesome website, so if you guys want to go check that out after this, I would highly recommend it. Thanks for joining us today, Heba. It's really nice to have you on the podcast, finally.   Heba Shaheed:  (01:19) Thanks so much for having me. I know we've been going back and forth for a while now.   Tahnee:  (01:23) I know.   Heba Shaheed:  (01:23) But yeah, it's great and I really hope I'm able to provide some insight on this wonderful world of pelvic health. It's kind of a bit, it's almost sometimes hard to understand if you don't really get it.   Tahnee:  (01:41) Yeah. In researching you and preparing for this podcast I listened to a view other interviews you did and I was, because I've got a bit of a background in anatomy too, and I think you made the point in one of them of how a lot of people when they imagine a pelvic floor they're thinking about a banana hammock shaped piece of tissue in the pelvic area that just contracts. And they don't really have much of a three dimensional concept or a visual of what the pelvic floor actually is and how it functions.   Tahnee:  (02:15) Is that fair to say when you start seeing people, that you're educating them as well as obviously working with them?   Heba Shaheed:  (02:22) Ah yeah, absolutely. Education is the first thing. Educating them firstly, part of that is anatomy and that it is a three-dimensional, multi muscle system. I think people picture the pelvic floor as just this one little muscle that goes from your pubic bone into your tailbone, but it's more complex than that. It's got a right side, it's got a left side. It's got muscles that go to your hips, muscles that go to your tailbone, muscles that go to your pubic bone, muscles around your vagina, muscles around your urethra, muscles around your anus.   Heba Shaheed:  (02:55) It's a very complex system and they all have to interplay together. It's more than just muscles, it's connective tissue and fascia and nervous system and an immune system. There's just so much going on down there that we're almost oblivious to how important it is. There's organs there as well. Your pelvic organs, your bladder or your rectum, your uterus if you're a female.   Heba Shaheed:  (03:21) A lot of that is just beginning with education about yes, anatomy, like your physiology. But then even more than that, it's education around simple things like habits. What's appropriate for emptying your bladder? How often should you be going? What position should you be emptying your bowels in? How long should you be spending on the toilet? What should your periods feel and look and how long should they last? And all that sort of stuff. It's a lot of, more advice around simple things like your basic pelvic habits that we often have to educate people. And they're coming to us when they're in their 20s, 30s, 40s, even up to their 80s and not having known such simple concepts.   Tahnee:  (04:11) Yeah. I think back to health ed at school, which was pretty poor. It's such a mystery area for so many of us. And obviously then there's all the cultural stigma around bums and vaginas and vulvas and all those kinds of things.   Tahnee:  (04:30) When you're talking about these general health markers I suppose, something I'm really passionate about educating women around, is it's not actually normal to experience bad periods. For example, I have my period right now, and apart from feeling a little bit more introspective and a little bit quieter, like physically I don't have symptoms and that took me quite a long time to work out through my own journey of course. I think that's the same with things like bowel movements and urination. These are natural processes that require a really complex interplay of the nervous system and the myofascia and all of these things.   Tahnee:  (05:16) They're bio-markers. They're ways of us actually assessing our overall, more holistic state of health, right? So if you were talking to someone, what would you say how many times should we be going to the toilet? And what should we be looking for? And same with bowels. What are the averages, I suppose, if there are any that you would be looking for?   Heba Shaheed:  (05:35) Mm-hmm (affirmative). I can empathise with you on that front of having had periods that weren't great. And I agree with you in that we've kind of normalised period pain to the point that we don't even acknowledge that period pain is not normal. It's to the point where, "Oh I know, that's normal. Everyone goes through it. That's, you just kind of have to put up with it. That's life as a female."   Heba Shaheed:  (06:04) But the thing is, we know that period pain it still comes along with, if you start off your periods having had severe period pain and then you go on to have severe period pain through your whole teens and your 20s and whatever, that actually sets you up for development or exacerbation of both bladder and bowel symptoms. Because, as you mentioned before, it is a very complex interplay of the myofascia, which obviously your uterus is connected to your bladder and your bowels, fascially and muscularly as well, and of course your nervous system, the nerves are all supplying the same kind of area, and then the immune system and so on, right?   Heba Shaheed:  (06:46) In terms of what is acceptable in terms of behavioural habits when it comes to the bladder and urination, unfortunately what I often see in my clinic, because I see mostly complex pain patients is, "Oh yeah, I go about two or three times a day to empty my bladder." And I'm like, "Well, that's not right." And they're like, "I have such a strong bladder, I only need to go two or three times and I can really hold it." And I'm like, "Well, that's not actually something to be proud of, because you're actually putting a lot of strain on your bladder when you do that. Actually what you should be doing, is going around about every three hours."   Heba Shaheed:  (07:25) The bladder capacity, think of a bladder like a balloon. It's deflated when it's empty and then that balloon slowly inflates and the nerves send us messages when the bladder's more on the full end. But, you should also be getting minor nerve messages saying, "Ah, yeah. It's a little bit full," or, "It's moderately full." But if you're only going when your bladder is like stretched to extreme capacity, that's not actually healthy. Every three hours is good. That's about four to six times a day, or six to eight times a day. Six is kind of like a good, round about average number. If you're going less than four times, then I find that unhealthy.   Heba Shaheed:  (08:07) It should be a steady stream, a straight stream. If your stream's going off to one side or spraying, that could indicate that there's something going on. There should be no burning. It should be a steady stream, there shouldn't be any start stop of the flow. The flow should be relatively normal, not too slow, not too fast. Unless your bladder's full, then of course it's going to be a little bit fast. We also need to pay attention to what's happening. I think a lot of people, even when they're coming to my clinic and I'm asking them these questions, they're like, "Oh, I don't know. I don't know if it starts and stops. I don't know if it's a slow flow. I don't really know. I'm not aware."   Heba Shaheed:  (08:50) Or things like you go to sit on the toilet and it takes a few moments before the stream actually starts. That's suggesting that something's off with the muscles there as well. It's like these little things that if we start to become aware, I mean obviously we don't want to be hyperaware in that we're just fixated on it. But it's just like little cues that your body's telling you that the bladder or urinary system is functioning optimally or not. That's that.   Heba Shaheed:  (09:22) In terms of your bowels, the literature is strange, in that it says three times a week is okay to go to the bathroom for bowels. But I really don't believe that.   Tahnee:  (09:35) Yikes.   Heba Shaheed:  (09:38) I really don't believe that that is [crosstalk 00:09:38]-   Tahnee:  (09:38) Is that the scientific literature, I suppose in inverted commas?   Heba Shaheed:  (09:41) Yeah. It goes from three times a week to three times a day, is the realm of acceptability.   Tahnee:  (09:48) Geez louise.   Heba Shaheed:  (09:49) Yeah. I'm not really a huge fan of that. I'm thinking of it biologically and physiologically and mentally, psychologically the impact of not emptying your bowels on a daily basis. I'm a big proponent of, bowels should be emptying every day. If you're eating every day, you should be emptying your bowels every day. And if you're not, then that is suggesting that something is off in the digestive system, or in the immune system or in the nervous system. And it is something that needs to be addressed.   Heba Shaheed:  (10:22) And the fact, the thing is because I work with so many women who have complex pain and chronic constipation, irritable bowel and Crohn's disease and all sorts of bowel disfunction, I know for a fact that every single one of them is able to achieve daily bowel movements. Regardless of whether they came to me having said, "I haven't been in a month," or, "I haven't been in a week." In clinical practice I'm able to get them to go every day. It further justifies my belief that we should be going every day.   Heba Shaheed:  (10:53) And of course, it's just logical that you should be going every day. If you're having three massive meals a day, you could very well be going three times a day to empty your bowels, right? And they could be three type four stools, which is like a long smooth sausage, and that would be considered healthy. I would say at the very least once a day, and up to three times a day is good. But it's more about the consistency of the stool as well. It shouldn't be, "Oh, I'm going three times a day, but it's coming out as small pebbles and I'm incompletely emptying."   Heba Shaheed:  (11:27) It should be a complete empty of a type three to four stool, which is a long smooth sausage, and it should be easy to come out and I should be done instantly, I shouldn't be sitting there for 20 minutes trying to empty my bowel. And there shouldn't be any pain when I'm emptying, there shouldn't be any fissures, I shouldn't be straining, I shouldn't have haemorrhoids popping out. It should be a complete empty and I should feel like once I'm done, I'm done. I don't have to sit there trying to get little bits and pieces out.   Heba Shaheed:  (11:58) And if you're feeling that there is, sensations that aren't as I described, then it is starting to suggest again, that there might be some dysfunction. Whether that's a pelvic floor dysfunction, so for example the pelvic floor muscles, because the pelvic floor muscles surround your rectum, one of the muscles is called puborectalis, it surrounds your rectum and another is your external anal sphincter, these two muscles are part of your pelvic floor and if they're too tight, then they can make you functionally constipated.   Heba Shaheed:  (12:33) A lot of people get confused in that they think, "Ah, I just have to have more fibre. Or I just need to drink more water." It's a very nutrition focused approach, which is important for sure, but there is also a type of constipation that is purely mechanical. It is the muscles of the pelvic floor are extremely tight, and then it's actually physiologically difficult to push your bowel motions out. Or they are dyssynergic in that when you visualise yourself trying to push out your number two, it's actually tightening instead, because you're having this poor coordination. Your brain is sending the wrong message to the muscle.   Heba Shaheed:  (13:15) This is where pelvic floor physio comes in. Because it's like, "Okay, what's going on? How do we figure it out?" How do we... that's why we have such a great success rate with functional physiological pelvic floor dysfunction based constipation. What else? Yeah, I think that's the main kind of things. When we do go to the bathroom for number twos as well, positioning is super important. As I mentioned before, puborectalis slings around your rectum. It's part of your pelvic floor.   Heba Shaheed:  (13:45) When you're sitting on the toilet in just a general normal position like you're sitting on a chair, that puborectalis muscle is kinked, right? But as soon as you elevate your feet onto a stool and you lean forward, that kink relaxes, so that pelvic floor muscle actually physically relaxes just by being in a squat position. So think, eastern countries and so on, where they squat to empty their bowels, that's actually physiologically healthy and normal. We need to replicate that in the western world and that's where you would get a stool, and you'd lean forwards to produce that same effect. And that, again, physiologically, physically releases the muscles and you're able to actually empty your bowels without having to sprain and or without feeling uncomfortable.   Tahnee:  (14:36) Yeah. We have squatty potties in every toilet in our house and office. They are-   Heba Shaheed:  (14:42) Perfect.   Tahnee:  (14:42) They are very popular. But it's interesting just thinking about that, because I was lucky enough to have a birth that I was in control of. And I found the birth also I wanted to squat to deliver my baby. My mum, as I was growing up, always talked about that as being the most natural position to deliver in. I remember when I studied physiology that bend in the pelvis as well, you can really when you start to look at the muscles in the anatomy you can see how being in that squat position just allows everything to relax.   Tahnee:  (15:17) I think one of these misconceptions around the pelvic floor is that we always want to be tightening it, because and I was taught this through more the Taoist tradition but we work a lot with jade eggs and I don't know, you might not be into this, but taught me certainly to actually be able to relax and contract my whole pelvic region. And one of the practises we do is like almost using the vagina like a hand to like swirl them up and then down through the vaginal canal.   Tahnee:  (15:49) The first time I tried that I was just, "Oh my God, I have no connection to the... Like I can't feel anything in there. I don't," it was like one area was quite strong and then everything else was really weak. Is that kind of a similar thing when you're doing internal exams, what you're noticing is that people are quite tight in certain areas, but then really unable to get their brain to talk to their tissue in other areas? Is that what you're talking about with the anal sphincter as well? Things just gripping and holding on?   Heba Shaheed:  (16:23) Yeah. There's varying presentation that would come I guess. I think the biggest thing is that we have a complete lack of awareness of our pelvic floor. That's number one. It's just this disconnect, like our mind, body disconnect between the, well with the pelvic floor and pretty much that whole female region.   Heba Shaheed:  (16:50) If we go back to firstly what you mentioned about birth, yes, we're traditionally and physiologically you're supposed to birth, not supposed to birth, but it's inherently more conducive to birth to be in a squat position, right? Because we know that physiologically that opens up the pelvic floor muscles. And whereas in more kind of medicalized births where they're lying on their backs, that's completely not conducive to birth at all, because just the fact of lying on your back shuts your tailbone, it doesn't allow that tailbone to move. And that in itself tightens up, well not tightens, but it reduces the capacity of the pelvic floor to open, right? Yes, you're in a contractile state rather than a relaxed state, which is what it's supposed to be and then a bearing down state which you're supposed to be in for birth. That's number one. That's birth, right? But then aside from birth, well to be honest for birth you need to be connected to your pelvic floor.   Tahnee:  (17:58) Mm-hmm (affirmative). Totally.   Heba Shaheed:  (17:58) The issue that we see a lot with now is things like obstetric anal sphincter injuries. And that's because it's almost like women have been told, "Push through your butt like you're trying to push out a poo." But that's not the same muscles. They're part of the muscular system of the pelvic floor, but the vagina is very different to your anal sphincter. The anal sphincter in your posterior compartment, which is why you'll end up with an obstetric anal sphincter injury and perineal tears. And your vagina is your medial, like the middle system, but it's also part of the anterior system of the pelvic floor. It's very different, even the imagery that we are giving women is completely inappropriate. That's number two.   Heba Shaheed:  (18:55) We need to be connected to our pelvic floor, but not just, and I guess this is what you're saying, is like part of it is strong, what part of it is weak and part of it is connected, but part of it's disconnected. Well, that's the thing. If a person is visualising the pelvic floor as that little banana hammock thing, then of course you have no idea what's happening in your pelvic floor, because it's beyond that. Like I said, there's part of the pelvic floor that surrounds your urethra, part of it that surrounds your vagina, part of it that's part of your anus.   Heba Shaheed:  (19:25) Then you have another part that is a triangle that goes from your pubic bone out to your sit bone and across to the other sit bone and it creates a triangle. Then you have your perineal muscle, which are also part of your pelvic floor. Then you have a deeper perineal muscle. Then you have puborectalis that goes from your pubic bone and slings around your rectum and goes around to the other side of your sit bones. Then you have iliococcygeus, then you have pubococcygeus. Now I'm just putting words out there.   Tahnee:  (19:54) Then all of those are ligaments.   Heba Shaheed:  (19:55) That they have no idea what I'm talking about.   Tahnee:  (19:57) Well, [crosstalk 00:19:57].   Heba Shaheed:  (19:57) Yeah.   Tahnee:  (19:58) They're all ligaments of the uterus and the bladder and the vagina.   Heba Shaheed:  (20:02) Exactly. You've got all the ligaments which are your, so you've got contractile tissue that's under your control, but then you have ligaments that you can't really [crosstalk 00:20:11] control.   Tahnee:  (20:11) Yeah, not innervated.   Heba Shaheed:  (20:12) Yeah, exactly. Then you have your connective tissue beyond that. You have fascia, pubovesical fascia, you have the rectovaginal fascia. You've got all this complex system that I feel, yeah it might sound like it's hard to understand, but if you're going to go and give birth, at the very least you can develop a basic understanding so that you're able to differentiate between a posterior compartment push, right, as opposed to an anterior compartment breathing and let go and just facilitation of birth. It's not about forcing birth, it's about facilitating birth. It's changing the focus from a straining kind of action to allow the body to generate force from within to facilitate the birth, right?   Heba Shaheed:  (21:12) You mentioned jade eggs. Yeah, in traditional cultures there has been an emphasis, and the thing is today a lot of the, I guess western pushers of jade eggs aren't using it accurately.   Tahnee:  (21:30) Yeah, I know. Don't worry.   Heba Shaheed:  (21:33) A lot of them are more about, yeah.   Tahnee:  (21:33) I have that pet peeve too.   Heba Shaheed:  (21:33) Yeah. A lot of them are more focused on, "Ah, let's tighten up the vagina and tight, tight, tight. And squeeze and tighten." And it's all about squeezing, right?   Tahnee:  (21:43) Yeah, and like better sex and blah blah.   Heba Shaheed:  (21:43) That's right. Like you want to have... The thing is even if you want to have better sex and you want to have better everything down there, it's actually every muscle has the ability to contract and relax. And the pelvic floor is part of that. The pelvic floor musculature, rather than just a muscle, the pelvic floor musculature needs to be able to engage in contraction and relaxation. And traditional cultures who were using the jade egg in more traditional form, we talk about the engagement of the muscles in a contractile state, but also in a relaxation state. It's a bit of, not ballooning, but it's opening. It's letting go as well. And that when you have the jade egg, you shouldn't feel discomfort in there. You shouldn't feel sticky and uncomfortable and painful, but it also shouldn't feel like it's just going to fall out. It's like two concepts.   Heba Shaheed:  (22:39) The jade egg is something that's used in traditional cultures, but in more physical-   Tahnee:  (22:47) Modern context.   Heba Shaheed:  (22:47) Yeah, modern physical therapy context, we use something similar, but it's, what are they called? Vaginal weights. So they use vaginal weights, which are usually like a silicone thing or a plastic type of thing which I'm not really a fan of, so a silicone type of thing with magnets or weights in there that helps. It's a similar kind of concept. And-   Tahnee:  (23:10) Yeah, because I use weights. But just I use crystals.   Heba Shaheed:  (23:15) Yeah. And it's in the sense of that they use them more again, for strengthening and coordination, but again there is that kind of focus on tightening things as well. Usually you wouldn't see vaginal weights being used in somebody who has already a tight pelvic floor. However, in saying that, I could see the benefits of doing that in a sense that you're getting them to be more aware of their pelvic floor. And for them to desensitise the pelvic floor. Because a lot of issues with pelvic floor, pelvic floor pain in particular, is that there is an over sensitisation of the nerves and the muscles and the connective tissue of the pelvic floor.   Heba Shaheed:  (24:03) Can we go back to, what was the last question that you asked me?   Tahnee:  (24:07) I feel like I've gone so many places now, I think I was asking about in examining women and what your actual experience was as a clinician, I suppose. In the back of my mind, because we don't know each other super well, but I've studied with this guy in Thailand who's a Chinese man. Part of his system is you actually have internal massage to relax all of the tissue. And they work on your psoas through your vaginal wall and the psoas attachment at the femur and everything. It's interesting.   Tahnee:  (24:45) Yeah, so [crosstalk 00:24:46]. I was curious as, because for me I had probably six or seven treatments in a period of time. And then obviously didn't find many people here offering that sort of thing. But it's become more common lately, I've noticed. I just wondered, because for me I could really feel where there were areas of tension and pain, and then areas where I was, like you were saying, desensitised or didn't have a lot of awareness. I had that pre-birth and it was, I think, one of the reasons I had such a great birth. Because it had given me some context and some of biofeedback. I was able to, I love manual therapies in general because they teach you how to connect into your body in this new way, the tactile kind of way. I guess I was leading into what is your experience as a clinician and what do you see?   Heba Shaheed:  (25:34) Yeah. I guess my qualification is as a physiotherapist, but I work specifically in pelvic floor right, and women's health. But even more deeper than that, my expertise lies in female pain. I work specifically with women as you mentioned earlier, with women who have sexual pain, pelvic pain, period pain, vulva pain. Very specific to dysfunctions of pain down there. If we talk about the guy in Thailand, in a lot of traditional cultures we know that they utilise a lot of abdominal myofascial work.   Tahnee:  (26:23) Yeah, that's what I'm trained in.   Heba Shaheed:  (26:24) Yes. And intrapelvic myofascial work. And that's kind of in that whole body worker type of thing. And it's a traditional kind of thing, but then there's the Westernised modern thing which is pelvic floor physical therapy or pelvic floor physiotherapy where there's a medicalised version of it. Depending on the physio that you see, because again we're also divided in our approach. A lot of physios are moving towards more of mind focusing thing where it's like change your brain, change your body kind of thing, was my approach is a little bit more hands-on.   Heba Shaheed:  (27:09) I'm like change the body and the mind and the heart all at the same time, integrate them all. I know that I'm very, I don't know, just a bit more progressive in my approach and I'm very open, because I've also studied. I did a lot of South American Mayan type of abdominal massage training.   Tahnee:  (27:31) Yeah, like Arvigo and stuff.   Heba Shaheed:  (27:32) And I've done Ayurvedic and Abhyanga type stuff. I'm very open to all disciplines and all medicines. I'm not the type that's like, "No. It's all just about evidence-based pelvic floor physiotherapy." I'm not like that. And I'm very open about the fact that I'm not like that. And it's not exactly, it doesn't sit well with a lot of the evidence-based physical therapists, but I don't really care anymore.   Tahnee:  (28:00) I was curious about that, because when I saw you, I saw that you were working in kind of in clinic and like quite, like at universities and things. And I was thinking that's interesting that you're so open-minded, because I've, I guess in my career, bumped up against a lot of people who are evidence-based who think a lot of the stuff we practise is really wild. I've seen amazing transformations, and I also believe strongly in evidence-based stuff as well, but I'm like traditional evidence is still evidence to me.   Heba Shaheed:  (28:31) That's right. And clinical practise is still evidence. The thing is I find that the discussion or the disputes kind of occur because a lot of people get so focused on evidence-based being what is researched and done in a trial and done in a research study, but the thing is, most practitioners regardless of whether you're eastern, western whatever, most practitioners aren't sitting in research studies. They're actually with people.   Tahnee:  (29:04) Every day.   Heba Shaheed:  (29:04) Fixing the people's bodies. They've treated thousands of people using their practises. And this is where Ayurvedic medicine and traditional Chinese medicine and all these other traditional medicines come in. They've been doing that for thousands of years with beautiful results, right? And it has nothing to do with sitting in a lab or in a research group or whatever. I think people forget that clinical practise is actually, so there's three type of evidence-based medicine. One of them is research study. But the other one is clinical practise. Thousands and thousands of hours of clinical practise.   Heba Shaheed:  (29:40) And you know what? It comes down to a personality thing. We are all structured, we all have proclivities, right? I have an extreme proclivity for openness. Openness to experience and openness to intellectual things and openness to all sorts of things. But then you have other people who are more about like conscientiousness in like orderliness, or very low on the openness scale. And that's fine. That's who you are, like whatever. We're going to attract whoever is aligned with us. That's the people that I attract to my clinic. Most of the people, well 95% of my clientele are like intuitive, feeling, empathetic type of people who are very disconnected from their bodies, which is pretty much exactly who I am.   Heba Shaheed:  (30:29) I'm very intuitive person, a very feeling person, and I was very disconnected from my body, that I didn't realise that I had all these pelvic pain problems coming up, but they were there from when I was little, I just didn't realise until my periods came, and it hit me like a tonne of bricks that I wasn't emptying my bowels on a daily basis, that I was holding my bladder and only going twice a day. All these little things that you don't even realise, and it comes down to just who you are I guess biologically and psychologically anyway.   Heba Shaheed:  (31:05) The people who are a bit more, I suppose, conservative would end up with the more conservative physios. And then the people who are a bit more liberal end up with the bit more of the open physios or a bit more with the open traditional type of medicine. You're going to attract whatever, and that's fine. There's room for everybody. There's room for everything. And so I guess if we go back to what you were saying about what do I actually encounter in my practice, because I see mostly pain patients, they're coming in with these pelvic floors that are really tight, really uncomfortable, the fascia's yuck the nerves are very sensitised and all sort of things.   Heba Shaheed:  (31:43) And because I have such a touch-based approach, like I do a lot of intra-vaginal massage with them, and I do a lot of abdominal massage. And not just that, I do whole body massage. I work through the whole, if you're looking at meridians or myofascial lines, I work up into their ribs. I work down into their feet. I work into their cranium. Whatever I feel like, because I'm more of an intuitive person, it's like they come in and I don't know. It's just a weird thing that I have. I don't know how to explain it, but I can just look at them and I'll be like, "Yeah, this, this and this." And then I work into it and it frees whatever's holding. It's like it's something deep inside that you just have. You either have it or you don't. Or you can grow it, I guess.   Heba Shaheed:  (32:28) That's why, some people say, "Oh, she's a bit woo." But I don't care. I'm like, "Yeah, I am, but it works." And my patients are attracted to that and they love that. And then while I'm working with them, I'm talking to them, like anatomy and stuff. In talking to them, to their rational mind too. Obviously there's a rational part of this. There's and intuitive part and there's a rational part too. And I'm talking to them. And usually when I'm working on something and it might be the psoas interiorly, right? And they were like, "Oh yeah, my ex-boyfriend was very abusive," or something like. Things come up. You know that when we interact with the psoas, you're talking trauma extroverting muscle. As soon as you start to engage with it, the person starts to remember and wants to get out the trauma that occurred or whatever.   Heba Shaheed:  (33:24) Part of that is also allowing them to verbalise stuff, because we know a lot of stuff is repressed or held in. And because I attract this certain type of clientele who are the type, they're usually very assertive females who are assertive in their life, what they want, they're all like a bit type A type personalities. Type A, type B, I guess, but then they don't put their own needs ahead. They're putting other people's needs ahead of their own. And then they hold things in and a lot of them are quite out of touch with what is actually their feeling, because they're just constantly looking after people around them.   Heba Shaheed:  (34:09) It's like getting them back in touch with, "Okay, what happened to you and how did it change your life?" It's more like I do a lot of coaching stuff with them at the same time. It's an integrated thing. I've been to a lot of other pelvic physios and I can see the difference in the way that I treat, because a lot of them will just sit there quietly and do the work. Or ask you about your weekend or something, and I can never ever remember what I've done on the weekend, so it's like well what's the point of that?   Tahnee:  (34:45) You have a three year old, it's like, "I don't know."   Heba Shaheed:  (34:48) [crosstalk 00:34:48]. Yeah, you're having a deep meaningful conversation where you're freeing a lot of repressed stuff, whether it's microtrauma or a macrotrauma, it doesn't matter, they're still traumas. Even microtraumas have an impact and they're repressing them. And when a body comes to me in that state of, this inflamed state of severe period pain, chronic constipation, bloating and all this stuff, oh man, there's shit going on in there. There's stuff. It's not just, "Oh yeah, I fell over on the weekend." It's not that. This is deep stuff. What do you have to do? You have to have a deep conversation, otherwise that person's going to be going from one therapist to another never really figuring out what's wrong with them.   Heba Shaheed:  (35:33) And they're the ones that end up, because they start with the modern medical stuff and then it's not working, and then they have all this surgery and it's still not working, then they end up seeing traditional Chinese Medicine and Ayurvedic Medicine and any of these traditional type of stuff, Mayan and whatever. And you know what? That's okay, because for you that is what is going to work, because it isn't just a body thing for you. When it becomes this complex and angry really, it is, there's like a poor alignment of your heart, your mind and your body. And it's trying to integrate all of them so that you actually feel like you're in control of your body, and it's not your body that's kind of controlling everything else.   Tahnee:  (36:19) Mm-hmm (affirmative). That's a such a common theme I think with women, is repressed anger and this sense that they have no control. I think especially women that are sensitive and like you were saying, empathetic and intuitive, because they take on so much and then it's this kind of push back or rage against what they've... It's their gift as well. I know you're an empath, and I am as well. It's my gift, it's also my curse sometimes. But I can feel, and that's certainly been my lived experience in my body, is when my own boundaries get brittle I start to really find that my body starts to lean back into the patterns that I've worked really hard to unravel.   Tahnee:  (37:11) I think it's just a constant process. But it sounds like you have such a holistic focus that people are able to work on that multidimensional level which I think, I mean for me it seems outrageous that that idea of bedside manner and all these things have been lost from the Western Medical system. Because, I think about just how important therapeutic touch and therapeutic listening is. I can remember going to older GPs when I was a little kid, who were like grandfatherly and gentle and kind. And just being in their presence was really healing. And I think now the system is really flawed obviously. But I can see how this disassociation of body from mind, from spirit has really led us down this path.   Tahnee:  (37:56) I'm super inspired to talk to someone who's actually gone through that system and continues to integrate, because I think that's really the future of medicine. That we need to have the evidence-based deep research and for me studying anatomy has given me so much power. But on the flip side of it, I have to keep remembering that the body is an integrated system and it's a holistic system and I can't just work on my pelvic floor and not have an overall effect on every single part of my body. It's this kind of dance always I think between the poles, I suppose, the Yin and Yang to use the Taoist ideas. But I mean-   Heba Shaheed:  (38:32) Yeah, well, it makes so much sense because what happened was in the last 50 or odd years or whatever, it really went into a more of a biological focus, like medicine went into a really biological focus. And then in the last kind of 20 years or so, they're like, "Oh no. We have to look at the mind as well." It's now kind of like a bio-psycho process, biological and psychological and then they're like, "Oh well, we know we do better in community." They're at this stage going to go into bio-psycho-social kind of thing. But the thing is, even the psycho-social stuff is still from a biological point of view, because it is like looking at psychology from a biological point of view.   Heba Shaheed:  (39:19) Really, depending obviously on what you believe in and stuff, and I'm assuming that obviously many of the people listening to SuperFeast are going to be more on the spiritual side. We feel like we have a, it's like a deeper connection, it's like a bigger connection, it's not just about my body right now. It's my body, it's my mind, but it's not just my body and mind, it's my heart and my soul as well. I need to be nourished in my soul too, for me to be really healthy. It's not just about always focusing on the physical elements.   Heba Shaheed:  (39:53) And that's part of it. It is part of it of course. You need to nourish your body to nourish your soul, but it's also vice versa. It's interesting. And the other thing that you mentioned before as well was about anger. One of the things that I've studied is when you look at, we have the mind or the head. And the mind and the head is where you hold fear. And then you have the heart, and that's where you hold shame. And then you have the gut or the pelvis, the gut and the pelvic paradigm where you hold anger. And that anger could be like anger to others, or it could be anger to yourself, or repressed anger.   Heba Shaheed:  (40:39) A lot of, that's often what we see. People are angry at themself, or they're angry at their bodies for not working the way that they want to, and it just feeds that cycle of anger. And their pelvic region gets worse and worse and worse. But if you really, really trace it back, you trace it right, right, right, right, back, there is that initial sliver of anger that started, but even before that there might have been an element of shame. There's even the heart isn't integrated. It could be shame, like shame at your own self. Or it could be a shame because somebody put a belief of shame onto you. Like, "Ah, that's not what girls do," or something like that.   Tahnee:  (41:18) Cultural.   Heba Shaheed:  (41:20) Yeah, cultural type of things. But it's somebody else's thoughts and feelings that you manifested of your own shame, or it's somebody else shame. Or even with a partner that you're with, or the parents, or whatever. Or society. And then even more so than that, your head is where you hold fear. Then what happens with a lot of my clients is that they get so stuck in their head, in that they're afraid that, "Sex is always going to hurt. That I'm always going to have period pains. Like, this is my life for the rest of my life. I'm never going to get better."   Heba Shaheed:  (41:56) It's like constant looping of fear in their head. What I try to do, is I try to get right to the beginning. It's like, "Okay, what was the first thought and feelings? What was the first thought?" If we go right back it could be something, a shameful thing that happened when you were two. Or it could be a fear driven thing that happened when you were just born. Maybe you were born to very abusive parents. Or like anger driven thing where you weren't allowed to be your authentic self, for example.   Heba Shaheed:  (42:33) It's like tracing it right back, because a lot of the time you can get so caught up in trying to treat the body, and then you think you're treating the mind because you're giving them pain education advice and all this stuff which is important, but at the end of the day the heart is completely not even involved. But I feel like that's really crucially important especially with the patients that I see, because they're all the kind of the feeling heart centred type of people. And then sometimes it's something as simple as, "I just hate my job. My heart's not in my job, and because I'm in my job," and I've had patients like this where it's like, she wants to be a naturopath for example, but she's working as a lawyer, you know what I mean? And she just hates her job. And I'm like, "Well, if your heart's not in it, your body's going to rebel against it."   Heba Shaheed:  (43:21) It's like even simple concepts like that could be the key that unlocks why a woman is having so much dysfunction.   Tahnee:  (43:31) Yeah. I can hear a little girl. Hello darling.   Heba Shaheed:  (43:35) She's dancing in the room.   Tahnee:  (43:37) Super.   Heba Shaheed:  (43:37) Spinning around, dancing.   Tahnee:  (43:39) Very cute.   Heba's Daughter: (43:39) Dah.   Tahnee:  (43:40) Yeah. It's you.   Tahnee:  (43:43) I'm curious-   Heba's Daughter: (43:47) Dah.   Tahnee:  (43:47) You're in a podcast darling.   Tahnee:  (43:50) I'm curious about complex trauma and pain and stuff, because one of the big epiphanies for me, I mean I was so scared of pain when I was 20. To the point where I've made some hilarious statements that now make me laugh. But I remember being 18 and 19 and saying, "There's no way I'm giving birth naturally. I need drugs to do that. I don't want to feel it." And obviously 10, 15 years later had a home birth naturally and blah blah. I changed. But a lot of the pain science and stuff I researched, I know that's an area you've studied a lot, like pain is just this completely subjective and incredibly difficult thing to measure and track. And so much of it is really due to this, I guess inability to be intimate with ourselves and to really give ourselves permission to have the full human experience, which is warts and all. It's not always sunshine and rainbows.   Tahnee:  (44:47) Is that kind of, I assume that's something because you work so much with really chronic difficult issues, is that something that you're always trying to educate people around? Is that, I'm not trying to say pain isn't real, because I feel like that's a really difficult thing to say, but it's sort of like from my experience, I've changed my relationship with sensation so much that pain and I have a very different relationship now. Is that what you're trying to work with people toward? Is to redefine their experiences, sensation and how they relate to their body?   Heba Shaheed:  (45:20) Absolutely. So it's all about perspective. We can create a relationship with our body that is pain driven. Or we can create a relationship with our body that's pleasure driven. Memories create little tags in your brain, neurotags, that can latch onto experiences as being with negative emotion or with positive emotion. And it depends on which part of your brain that you're using. We know that the right side of the brain is more associated with negative emotion, and the left side of the brain is more associated with positive emotion. Actually, we know that people, the ideal, so positive emotion isn't to do with being happy. Positive emotion is to do with not suffering. We don't want to suffer. And pain is an embodiment of suffering. We don't want to be in pain. If you're the type that is so fixated on not wanting to be in pain, that you'll use that-   Heba's Daughter: (46:25) Mum.   Tahnee:  (46:25) Exactly.   Heba Shaheed:  (46:31) If you're the type that doesn't want to be in pain, you'll become so fixated on that, you can become so fixated on that negative emotion, because you don't want to suffer, but unfortunately that actually propagates the feeling of suffering because you've become so fixated on that part of your brain that, because pain in itself is a negative emotion. Now here's the thing, right? Your brain actually doesn't know the difference between truth or lies. And this is a fact. It doesn't know. It's what you feed it. The food that you give your brain, food that you give your mind, is going to nourish it. If you're feeding it negative thoughts, which is fear of pain, and fear driven messages, and suffering driven messages, negative polarity based messages, then the brain will be nourished by that. And it will become hyper aware of that.   Heba Shaheed:  (47:28) But on the flip side, if you're feeding it positive thoughts, like I'm safe. I am content. If you're sending it positive messages, that will then nourish the brain in that sense. Think of it as like negative emotions and negative messages drying out the brain and making it hard and inflexible and uncomfortable. And positive thoughts and feelings and messages nourishing the brain and lubricating it, and filling it up that the brain is sitting in a soup, and it's relaxed and chill.   Heba Shaheed:  (48:01) Firstly a lot of it is just education on that sort of thing. Like visualisation based education, but then also anatomical and physiological based education in that explaining the actually neurophysiology of pain can be very helpful. But not just explaining that, but also getting them to do little workbook tasks to help them identify their patterns and behaviour. Because, remember a lot of it is beliefs driven as well. If you have this belief, that belief can be changed. We know that the brain is plastic, it's neoplastic. That means that it can be changed.   Heba Shaheed:  (48:40) Within three months, six months, 12 months, you'll have a completely different brain and cells in your body, if you continue to send it specific type of messages. That's why we can see a person, for example myself, I had like a 100 out of 10 pain 10 years ago. Literally every moment of every day was severe, excruciating neuropathic pain. From migraines to pelvic pain, or pain down my leg, sciatic nerve, and just like fibromyalgia type, like just horrific pain. That was because I was so fixated on the pain and the fear that I was always going to be in pain. Remember what I said about the head space being driven by fear.   Tahnee:  (49:29) I know. I call is the loop, like that constant feedback.   Heba Shaheed:  (49:32) That's right. And the thing is, that is very draining. That is very, very draining. Then you've got this rock hard brain that is completely devoid of lubrication, whereas today 10 years on, I can't even remember the last time I had a migraine. I can't remember the last time I had severe period pain. You can very drastically change it. And it's a constant work of it on daily basis. Obviously there are some times where I might regress and it's oftentimes where my mental state isn't well. Like if I fall into severe depression because of whatever, at the end of the day it is my thoughts and feelings. But certain events can trigger it.   Heba Shaheed:  (50:21) And that also comes down to trauma. We were talking about trauma just before, you mentioned trauma just before. Trauma, especially childhood trauma effects your hard-wiring. I was born into a very malevolent, narcissistic personality disorder family. To the point where there were times where I would be left by myself in the apartment crying my head off under the age of one, because of like no safety. No... Obviously that would've triggered a, what's it called? Fight or flight response in the brain. And we know that the nervous system is divided into two. Your sympathetic nervous system which is your fight, flight, freeze or fawn system. And your parasympathetic nervous system which is your relax, reproduce, digest, rest, chill system.   Heba Shaheed:  (51:17) If a baby is living in a chronic state of sympathetic nervous system hyperactivity, fight or flight, screaming and crying and being scared and feeling unsafe and all this sort of stuff, that's going to send your nervous system into overdrive. And your brain is just going to shrink, not shrink, but it's just going to become like that dried sponge. If it's a dried sponge, well all your nerves are coming out from your brain, well then those nerves aren't lubricated. Your immune system is then compromised. Your immune system is largely lubrication, right? It's mucous membranes.   Heba Shaheed:  (51:57) That's what I mean about going right back with my patients is that we're trying to figure out what caused this nervous system to go nuts? What caused your immune system to go nuts? And the musculoskeletal system is only the end product, the end thing. This all started way back when. It's like, "Okay, how do I then manage that?" Because I was one of those kids that when I was young, I had all this auto-immune stuff, like severe asthma, eczema, this condition called vitiligo where my skin turns white if I'm like severely stressed.   Tahnee:  (52:34) Yeah. I've seen that.   Heba Shaheed:  (52:36) It was just like super auto-immune type condition. And a lot of this stuff said, "Ah people say it's incurable. You'll just have to live with it. And maybe you'll grow out of it or something like that."   Tahnee:  (52:44) Those people are wrong.   Heba Shaheed:  (52:46) That's right. Exactly, because it's your immune system. Your immune system doesn't care, like it's trying to tell you that, "Help me. Help me. Save me. I need to feel safe."   Tahnee:  (53:03) This is the thing. If it's this line of defence, our protection and we're constantly being bombarded, like you're going to end up with immune responses.   Heba Shaheed:  (53:13) Mm-hmm (affirmative). If a patient comes to me and then they report to me that they had childhood asthma. I'm not going to be like, "Oh, you just had asthma." I'm going to be, "Woo, hang on."   Tahnee:  (53:21) Yeah, what happened?   Heba Shaheed:  (53:22) "Why did you have childhood asthma? Why did your immune system react like that?" And it's like 99% of the time that my patients will tell me and I'll be the first person that they've ever told, "Oh yes, this happened to me when I was little." Or something like that. There's a really, there's quite a correlation between persistent pelvic pain conditions and childhood trauma, whether we recognise it or not. And it could be just neglect. It could be neglect, it could be severe abuse, it could be sexual abuse, it could be physical abuse, emotional abuse. It could be anything. It could be sibling abuse, right?   Tahnee:  (53:55) I think even like-   Heba Shaheed:  (53:55) Or it could be bullying at school.   Tahnee:  (53:56) Yeah, I had a really, my family are loving and kind. But my parents had a really weird relationship and I'm super sensitive and I think took on a lot of that. And I disassociated from the body really early. I remember my mum having to be like, I'd be like, "I'm sick." And she's like, "Have you pooed today?" And I'd be like, "Oh yeah. I have to poo." I fully had that complete lack of biological connection. And it'd like that was my whole 20's it was working back to that. It's really interesting, because if I look at it, it's like I had a really happy childhood, but even just being in that energy all the time because I was sensitive to it.   Heba Shaheed:  (54:34) Absolutely.   Tahnee:  (54:35) It's like I can't [crosstalk 00:54:36] put blame onto them, but I have to do my own healing now to work out what my boundaries are.   Tahnee:  (54:43) And I'm curious, because you're an empathetic person and you're working with a lot of people's pain and suffering. Do you have boundaries for yourself on how much you can take on? Or how do you handle that sort of work?   Heba Shaheed:  (54:54) Ah yeah, for sure. I have massive, massive, massive boundaries. I only allow myself to work once to twice a week, and it depends on the week, it depends on my menstrual cycle.   Heba's Daughter: (55:09) I'm hungry.   Heba Shaheed:  (55:13) And with my patients, I used to think it was better to have breaks between patients, but it's not. For me, I need to just see them bang, bang, bang, one after the other with no break. Because then I don't allow all of the emotions to overwhelm me between patients.   Heba's Daughter: (55:32) I'm hungry. I'm hungry.   Heba Shaheed:  (55:35) That's my daughter crying out, "I'm hungry. I'm hungry."   Tahnee:  (55:38) I know, we're nearly finished, darling. They eat so much at three. My daughter's like a bottomless pit.   Heba Shaheed:  (55:44) I know.   Tahnee:  (55:44) It's ridiculous.   Heba Shaheed:  (55:48) Yeah, so.   Tahnee:  (55:50) Boundaries.   Heba Shaheed:  (55:50) Yeah, so boundaries. Yes, I discovered for myself that I need to see them bang, bang, bang, one after the other, because I couldn't allow myself to experience the overwhelm of emotion in between patients, because then it would be too draining to see the next patient. And then what I do is, I only, I actually see a lot of patients in one day. I can see between eight to 12 patients in one day, which is quite-   Tahnee:  (56:18) Whoa.   Heba Shaheed:  (56:18) A lot for-   Tahnee:  (56:18) That's heaps.   Heba Shaheed:  (56:20) Yeah. That's why I only work one to two days.   Tahnee:  (56:23) Yeah. Sure.   Heba Shaheed:  (56:23) And it depends. I do these really weird stuff, but before I go to work I tell myself, "Okay, who am I going to be today?"   Tahnee:  (56:38) Good. Yeah. I love this stuff.   Heba Shaheed:  (56:42) Which mask, which costume am I going to put on today? Even like now when I'm talking to you, this isn't the real, like it is, it's a part of me.   Tahnee:  (56:51) Yeah. It's one aspect of you.   Heba Shaheed:  (56:52) Mm-hmm (affirmative). But like the real me is actually very quiet and I kind of stick to myself, like a very introverted type of person. But, I'm like, "Okay, which costume am I going to put on today?" And that almost serves as like a physical barrier between my emotions and theirs. And then I have to physically tell myself, "Everything I feel today, none of this is my emotions. Anything that I feel," so like if I'm with a patient, the patient walks in and I immediately feel depressed, I'm like, "I know I am not depressed. She is depressed. Why is she depressed? What's happening?" Or if a patient walks in and they're like super happy, super excited and I suddenly feel like really bubbly and stuff, I'm like, "I know," I'm like, "Yes, I have the capacity," like obviously you have a capacity to be depressed and bubbly or whatever, "but in this moment every emotion that I'm feeling, is her emotion."   Heba Shaheed:  (57:45) Being conscious of that, so when the person walks in having that immediate consciousness of, "This isn't my emotion." And in that way I'm able to kind of, so I reflect. I imagine myself as a mirror and I'm reflecting her. So whatever I'm feeling is only hers. What I do, and this is a really amazing thing I've discovered is like I feel her emotion and then I allow myself to process her emotion, and then I actually speak out her emotion to her. I rationalise what she's feeling. And then she comes back to me with something, but it's allowed her to heal in that moment, that emotion that she was feeling, because instead of just feeling it inside, we've brought it to her outside. She's extroverted it out.   Heba Shaheed:  (58:30) And that in itself can be really powerful. What I've done, is I've also rationalised that it's not my feelings. It's like being very, very in the moment conscious of everything that you're feeling isn't actually your feeling, and it's theirs, but you're also letting them process their feelings. It's a really amazing thing to be an empath in the sense that you can allow other people to actually sort out their own feeling. It's a really amazing thing.   Tahnee:  (59:00) Yeah, in mirroring them.   Heba Shaheed:  (59:02) Yeah. And then-   Tahnee:  (59:04) Do you have meditation practises or anything as well around that? Or you just-   Heba Shaheed:  (59:07) What is it?   Tahnee:  (59:10) What do you do other... like yeah, obviously you're going to keep talking, so go. I jumped in.   Heba Shaheed:  (59:14) Oh, I was just saying and then at the end of the day I get on the train back home, and all I do is just filter everything out. I'm like, "Okay, what am I feeling right now? Is it mine? Or is it someone else's?" And then just letting it out. And then by the time I get to my car to go pick up my daughter, I've already sorted everything out, because I'm on the train for half an hour or whatever. It's like, "Okay, I've done it." And then it's like I could be super drained if I just let myself, because the thing is you have to filter them. Because in the past I hadn't done that and I would be so exhausted.   Tahnee:  (59:46) Oh it smashes you, yeah.   Heba Shaheed:  (59:47) After a day of work. Ah, my God, like I would be dead literally, and I'm just, "Leave me alone. Don't talk to me. I just cannot deal. I need to be on my own." But if you do that filtering process, and then you reflect on the day. And you reflect on how much you helped them, because remember as an empath helping other people, helps you as well. You feel that sense of, you get energy from that. And then it's the end of the day. And then I go pick up my daughter and I'm fine, because I know what's my feelings and what's not.   Heba Shaheed:  (01:00:17) I could do this every day if I wanted to, because I've kind of gotten really good at filtering my feelings, but I don't want to. Because I know there's a capacity to give, right? And a capacity to give, because we're giving people, but then there's also an importance of individually as well. I need to also be myself and do stuff that I want to do, and it's not always just about work and helping other people.   Tahnee:  (01:00:41) Yeah. And being a mum as well. For me certainly when I had my daughter, my priorities shifted a lot around she needs me more than others do a lot of the time. That's the priority.   Heba Shaheed:  (01:00:53) Absolutely. Especially that zero to seven really, it's like they need you, to nurture them.   Tahnee:  (01:01:02) Yeah. I wonder, I'll start wrapping up, but I was wondering if you had any advice for home care for the pelvic floor for people. Because I get frustrated that the Kegel thing, because I'm like that's not really good enough. But for so many people, it's pretty foreign territory down there. Is there stuff that people can-   Heba Shaheed:  (01:01:25) I'm not really a huge fan of Kegel, I actually am like well what the?   Tahnee:  (01:01:30) Yeah, it's just more tightening which people don't need.   Heba Shaheed:  (01:01:33) Yeah, so I don't. My focus for home care is more around your daily habits. We talked about it right at the beginning. Healthy bladder habits, going every three hours. Healthy bowels habits, going every day. And that means eating well, because we know your diet heavily influences your ability to empty your bowels. And just healthy bladder habits, healthy bowel habits, sexual health habits and vulva health habits as well. Like not using all these creams and douches and washes and all this stuff. The vagina's a self cleaning machine.   Tahnee:  (01:02:07) Leave it alone.   Heba Shaheed:  (01:02:08) Just use warm water. Yeah, just leave it. Don't put anything in there, except if you're having penetrative intercourse or if you're using jade eggs and whatever, that's okay as well. But, just leave it. Let it do its job, kind of thing. You don't want to mess with the PH and all that. And when you're having sex, simple hygiene practises.   Heba's Daughter: (01:02:31) [inaudible 01:02:31].   Heba Shaheed:  (01:02:31) Like washing your hands and stuff beforehand. And wiping from front to back. And emptying your bladder after sexual intercourse rather than before. And using a tissue. Stuff like that. Just simple sort of stuff. And even like the underwear that you wear and the pads that you wear. I'm a very, because I know this, I've seen it, like just simple thing of changing your pads to an organic cotton pad, or a menstrual cup or something, can be very helpful, rather than a lot of these mainstream pads and stuff that are like heavy with perfumes and toxins and stuff like that.   Tahnee:  (01:03:10) Yeah. And that stuff actually gets into your tissues and create issues.   Heba Shaheed:  (01:03:12) Mm-hmm (affirmative).   Heba's Daughter: (01:03:12) [crosstalk 01:03:12].   Tahnee:  (01:03:14) Yeah, inflammation. Okay, well, I think you have a little darling that needs you.   Tahnee:  (01:03:21) I will say thank you so much for your time and for this conversation. I really enjoyed speaking with you. And for anyone who wants to connect with Heba, she's on social media @thepelvicexpert and she's also online at www.thepelvicexpert.com.   Tahnee:  (01:03:36) I saw you have some courses up there. People can have online consultations. There's lots of ways people can reach you. Is there anything I've missed? Or anything else you wanted to add?   Heba Shaheed:  (01:03:46) Yeah, no that's all. If you are in Sydney and you do want to book a consult, if you have any complex

In Episode 22, we get down to the real truth with Heba Shaheed, in regards to period pain, the many myths surrounding PMS, how to be more in tune with our bodies and the importance of mental health overall! Heba provides women’s health and pediatric pelvic health services including physiotherapy, exercise, nutrition and pain education. She specializes in sexual pain, pelvic pain and endometriosis just to name a few! Through her personal story, Heba unravels almost everything we need to know about our bodies, such as where do migraines come from or what’s the difference between a migraine and a headache? We learn if there’s a difference between a natural birth vs a C-section when it comes to the effects they have on your pelvic floor. Trust me we don’t hold back and Heba answers all of your questions in this special episode. It’s time that we learn more about our bodies and remove the shame behind wanting to know what really goes on down there!Enjoy and remember to follow us on Instagram: @unsweetenedandunfilteredFollow Heba on Instagram: thepelvicexpertCheck out her website: thepelvicexpert.comShop FabFitFun: Use coupon code UNSWEETENED for $10 off your first box at www.fabfitfun.com

#94 Heba Shaheed is the Founder of The Pelvic Expert - a one-stop digital destination providing evidence-based and holistic women's healthcare programs for pelvic pain, pregnancy and postpartum problems. Heba has a decade experience as a women's health coach and physiotherapist holding a Bachelor of Applied Science (Physiotherapy) from the University of Sydney, and numerous postgraduate certificates in pelvic rehabilitation, women's health, pilates, yoga, functional exercise, holistic nutrition and pain science. She has collaborated with some of Australia's leading obstetricians, gynaecologists, colorectal surgeons, pain medicine specialists and advanced laparoscopic surgeons. Heba is on a mission to give women's health a voice and openly talks about taboo topics such as periods, incontinence, constipation, pelvic organ prolapse and painful sex. Heba is especially passionate about raising awareness of chronic pelvic pain conditions such as endometriosis, adenomyosis and IBS. In this episode we cover The link between chronic constipation and pelvic floor dysfunction The difference between Slow Transit Constipation and Dyssynergic Constipation, both of which are drivers of chronic constipation The signs and symptoms of Pelvic Floor Dysfunction How one can improve their pelvic floor function if they experience dyssynergia or Slow Transit Constipation How pelvic floor dysfunction is diagnosed Heba’s thoughts on biofeedback for pelvic floor dysfunction And as you can imagine being the topic of constipation we get into the nitty gritty of so much more

Today we discuss everything pain and endometriosis! We learn a lot today with Heba Shaheed. Here's a little more about our guest: Heba Shaheed is the Founder of The Pelvic Expert - a one-stop digital destination providing evidence-based and holistic women's healthcare programs for pelvic pain, pregnancy and postpartum problems. Heba has a decade experience as a women's health coach and physiotherapist holding a Bachelor of Applied Science (Physiotherapy) from the University of Sydney, and numerous postgraduate certificates in pelvic rehabilitation, women's health, pilates, yoga, functional exercise, holistic nutrition and pain science. She has collaborated with some of Australia's leading obstetricians, gynaecologists, colorectal surgeons, pain medicine specialists and advanced laparoscopic surgeons. Heba is on a mission to give women's health a voice and openly talks about taboo topics such as periods, incontinence, constipation, pelvic organ prolapse and painful sex. Heba is especially passionate about raising awareness of chronic pelvic pain conditions such as endometriosis, which affects 1 in 10 women worldwide; she has hosted webinars and interviews with leading international experts in endometriosis, and is an advisor to the Endometriosis Special Interest Group, formed by Endometriosis New Zealand. www.thepelvicexpert.com www.hebashaheed.com @thepelvicexpert ____ What are you waiting for? Listen, download, subscribe, comment and rate!!! (like for real, I need you to do that) and get in touch with me at www.vagesteem.com or on: Twitter: https://twitter.com/vagesteem instagram: http://instagram.com/vagesteem Facebook: https://www.facebook.com/vagesteem Text us or leave a vm at 443-692-7802

This episode is all about pelvic floor therapy for endometriosis and the huge role it can play in helping us live well with the disease. Heba Shaheed is the founder of The Pelvic Expert, an online platform that provides programmes and courses on pregnancy, birth recovery, chronic pelvic pain and menstrual issues - including endometriosis. Heba is a women’s health coach, yoga and Pilates teacher, physiotherapist and fellow endometriosis warrior. She provides support to people with endometriosis through her courses, talks and classes, and has recently developed an online programme specially for those of us with endometriosis. In today’s episode, we talk about the link between the pelvic floor muscle dysfunction and endometriosis, and how endometriosis negatively affects our nerves and muscles, as well as how our muscles and nerves actually impact our experience of endometriosis. We explore the role of physiotherapy and pelvic floor therapy can have in healing some of the nerve and muscle damage caused by chronic pain and scarring, how we can start supporting our pelvic floor with physical therapy exercises for endometriosis at home, how to find a practitioner and what to expect from a pelvic floor therapy session. We also wrap with Heba’s key endometriosis natural treatment options. I learnt SO much in this episode, Heba is a fountain of knowledge and I’m sure you’ll love this episode. This episode is sponsored by BeYou Cramp Relief Patches. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches. Click here to find out more and to shop: https://beyouonline.co.uk/pages/how-it-works This episode is also supported by The Know Your Endo Endo Toolkit, a practical programme for managing endometriosis by Jessica Murnane. Use the code JESSICA at check out for $15 early bird and standard pricing. Click here to get course info and to enrol: https://knowyourendo.com/program This episode is additionally supported by The Gluten Free Baking Academy. A four week online course teaching you the tools, recipes, and know-how to confidently bake in the comfort of your own kitchen. You’ll learn to make incredible flatbreads, quick breads, yeasted breads, and sourdough without dairy, gluten, eggs, or ingredients like gums and highly processed starches or flours. To take a free course tour or to enroll, click here.   Links: The Pelvic Expert Website The Pelvic Expert Endometriosis Blog Posts Endo Ease Course TENDO - Endometriosis Summit Download

Pelvic floor expert, Heba Shaheed talks to physiotherapist, Joelene Murdoch from The Physiotherapy Clinic, about tackling the infamous mummy tummy. Are you doing those pelvic floor exercises correctly? Find out in this episode! 

Join physiotherapist and pelvic floor expert, Heba Shaheed in episode five as she talks to midwife and mum of two, Edwina Sharrock from Birth Beat, online antenatal education classes. Find out what childbirth actually feels like and how we can best prepare for it.

Is it safe to have sex while you're pregnant? Is it normal for sex to be painful? How can couples get back to intimacy post-birth? Join physiotherapist and pelvic floor expert Heba Shaheed as she talks to clinical sexologist, Tanya Koens from Surry Hills Therapy, to answer all your questions about sex and pregnancy, and intimacy post-birth.

Getting back to exercise after childbirth is too often accompanied by a little bladder leakage - an embarrassing situation that physiotherapist and pelvic floor expert Heba Shaheed says is mostly preventable and recoverable. So what do we need to know? Heba talks to fitness trainer and mum of two, Magdalena, about recognising the symptoms, pelvic floor training and recovery.

Endometriosis is a condition that affects 1 in 10 women. In episode two, physiotherapist and pelvic floor expert Heba Shaheed puts endometriosis under the microscope with Melanie, mum and former client. They talk about its impact on fertility and pregnancy, and look at holistic options to manage it

Lower back pain is pretty common, but it can be especially debilitating during pregnancy. Natalie shares her story with host and pelvic floor expert, Heba Shaheed. Find out what worked for her and how you too can reduce and manage lower back pain and pelvic pain during pregnancy.

Bellies, Bits & Babies is a new Babyology podcast all about women's pelvic health that answers the questions we're too embarrassed to ask, hosted by physiotherapist and pelvic floor expert, Heba Shaheed. Speaking with both experts and mums who share their own personal experiences, Heba covers everything from how to tackle the mummy tummy, lower back pain, birth plans and endometriosis.Launching September 10.

Hands down, Heba is the most interesting, bias-shattering guest we’ve had, and you can bet we’ll have her back! She is completely unafraid to tell it like it is, so we went there. Oh, we so went there because, friends, POP affects people globally, from all backgrounds, regardless of their beliefs, culture, sexuality, etc. Seriously, [...]

Hands down, Heba is the most interesting, bias-shattering guest we’ve had, and you can bet we’ll have her back! She is completely unafraid to tell it like it is, so we went there. Oh, we so went there because, friends, POP affects people globally, from all backgrounds, regardless of their beliefs, culture, sexuality, etc. Seriously, [...]

Heba Shaheed is the co-founder and CEO of The Pelvic Expert; a digital wellbeing platform specializing in maternal, menstrual, and hormone health. Heba was inspired to work in the space following her own challenges that include a 15-year history of chronic pelvic pain and endometriosis and witnessing the devastating effects of birth injury following her sister's first birth. Heba is a leading authority on women’s pelvic health and is a media commentator on this important, and under-represented, issue who regularly speaks at international health and women’s conferences. In this episode, we’ll be discussing why surgery alone is not enough when treating endometriosis, the biological reasons endometriosis is so painful, the fertility factors that come into play when experiencing endometriosis and considering surgery, how your diet can impact your endometriosis, and more! To learn more about Heba Shaheed, visit the show notes.

Heba Shaheed is co-founder and CEO of The Pelvic Expert (thepelvicexpert.com), a digital wellbeing platform specializing in maternal, menstrual and hormone health. She was inspired to work in this space following her own challenges with 15-year history of chronic pelvic pain and endometriosis, and after witnessing the devastating effects of birth injury following her sister's first birth. A qualified physical therapist in Sydney Australia, she has supported more than 2000 women on their journey to better health and wellbeing, and instructed more than 1200 therapeutic yoga and Pilates exercise classes.

Heba Shaheed is pelvic specialist and physiotherapist. She also has endometriosis and has a newborn, so she's well placed to talk about starting a family when you have the disease. She opens up about her own experience, the rocky road to diagnosis, and what women with endo can do when they're looking to start their own families.

Do you work with pre and postnatal women? Molly Galbraith from Girls Gone Strong joins Australian physiotherapists Marika Hart and Heba Shaheed to give us the down low on the upcoming launch of the Pre and Postnatal Coaching Certification program