In the third trimester the ‘sixpack’ abdominal muscles separate to allow room for the baby to grow. Within the first three months postpartum, in about half of women these muscles come back together properly. In the other half a separation remains, known as a diastasis recti.

We hear about this often as an aesthetic issue. It can create a ‘mommy pooch’ or it still might look like you’re pregnant. And while that’s a totally fine reason to seek care, the issue goes much deeper (quite literally).

A diastasis means something in your core system is compromised and is linked to low back pain, incontinence, prolapse and painful intercourse. It can be an underlying driver of pelvic health issues.

In this episode we go through a simple self-evaluation to determine if you might have a diastasis, but the gold standard is a thorough evaluation from a pelvic floor physical therapist.

Most people go directly to trying exercises they find off the internet. But there’s no one size fits all approach for treating a diastasis. A pelvic floor therapist will identify why the muscles haven’t closed up, manually work to address the issue, and only then will exercises be effective.

No matter how long it’s been you can absolutely still resolve a diastasis (without surgery). Whether your goals are aesthetic or functional, treating a diastasis can improve both.

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

The answer will surprise you! The myth that acidity in the body or bladder is responsible for IC symptoms is one of the most harmful out there.

In this 'sode we go through why the pH of urine has no effect on symptoms, how 'acid in' does not equal 'acid out', and what we should be doing instead. We hope this 'sode helps to free you from 'food jail' and you can become more confident in what you eat!

The Myth: Ingesting acidic foods or beverages makes urine more acidic, irritating the bladder and flaring symptoms.

The Truth: While some acidic foods are common triggers for IC, the body is extremely complex and 'acid in' doesn't equal 'acid out.' Many foods that contain acid are considered entirely 'IC-safe,' while some basic (meaning non-acidic) foods and drinks can also be major triggers. Furthermore, acidic urine has been proven to be no more painful than neutral urine for patients with IC.

The two rules of diet changes with IC are simple: avoid your personal trigger foods and eat healthy. It doesn't have to be any more complicated than that.

PelvicSanity Remote Consultation

If you're local to Southern California, we'd love to work with you to address the 'why' of your symptoms and help you find lasting relief!

If you're not in SoCal, we can still help! Check out our Remote Consultation Program (www.pelvicsanity.com/remote) for how our team can get you on the path to healing.

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

There's a wide variety of expertise when it comes to pelvic floor physical therapy. Unfortunately many patients have to go to several different ones before finding a true expert.

You might think that finding a pelvic PT who has a lot of experience means you'll be getting great care. But that's not necessarily the case.

In this 'sode we discuss why experience doesn't necessarily equal quality. In fact, sometimes more experienced therapists are still using outdated techniques they learned 20+ years ago, while someone newer to the field was trained in more contemporary methods.

So what should you be looking for to ensure you get the best care? Really, you're looking for three things:

1. Specialty Clinic: You want to find a practice that specializes exclusively in treating pelvic health. It means they have more experience with people like you and is much more likely they have specialty training instead of just 'dabbling' in pelvic health.
2. Hour-Long Treatment Sessions: You want to work hands-on and 1:1 with your pelvic PT for a full hour. No aides, no watching you exercise, no double-booked patients so they can't focus on you the entire time. These conditions are complex and you need time with the actual specialist!
3. Both internal and external treatment at every visit: Often it's only one or the other. Some pelvic PTs don't have the skills to work outside the pelvic floor, and they are just doing internal or using biofeedback the whole time. Others just 'check' the pelvic floor once and then treat entirely externally. You need the combination to see the whole picture.

Local to Southern California?

We'd love to work with you to completely resolve your incontinence and pelvic floor issues. If you're local to Southern California, please give our PelvicSanity (www.pelvicsanity.com) team a call - we'll be happy to answer any questions and get you started!

Whether we're your first call or you've been to multiple other pelvic PTs and physicians, you can absolutely find lasting relief!

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

Incontinence is certainly common. More than half of people have incontinence after a baby, it can accompany pelvic pain, prolapse, low back pain or following a surgery.

But it’s never normal, and never something you have to live with.

Sometimes this is normalized - we joke about it with friends, or hear about it from our mothers. But we often don’t recognize the profound effect of incontinence on our lives.

We often abstain from exercising (which has life-long health effects). We don’t feel comfortable doing certain activities with our kids. It dictates what we can wear. Many people find they are making a lot of sacrifices because of their incontinence they didn’t even think about.

Fortunately, it’s absolutely something that can be resolved by a qualified pelvic PT - and generally without Kegels!

Fundamentally, incontinence is the inability of the pelvic floor muscles to perform their job of holding back urine.

But this doesn’t mean they are weak! In fact, many times incontinence is actually due to overly tight and irritated muscles incapable of performing their normal job.

Incontinence is not normal and not something you have to live with. I’ve never had a patient not find improvement with pelvic PT, and the vast majority can completely eliminate incontinence without surgery, medication or a lifetime of pads

Local to Southern California?

We'd love to work with you to completely resolve your incontinence and pelvic floor issues. If you're local to Southern California, please give our PelvicSanity team a call - we'll be happy to answer any questions and get you started!

Whether we're your first call or you've been to multiple other pelvic PTs and physicians, you can absolutely find lasting relief!

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

For many people (almost 90% of those diagnosed with IC) tight muscles in the pelvic floor irritate the nerves running through the area. One of the most important of these is the pudendal nerve.

So what symptoms might be caused by pudendal nerve irritation? One is urethral burning or pain. One branch of the pudendal runs right to the urethra, so it is often responsible for urethral pain or burning.

The pudendal can also be the cause of urinary urgency and frequency. It connects to the bladder. Usually these nerves are ‘silent’, but with IC they are often activated and continue to send signals to the brain. When the brain interprets these as the urgent need to urinate, we get urinary urgency and/or frequency.

(Just a note - Often when we hear ‘pudendal nerve’ we do a Google search and see information about pudendal neuralgia. This is obviously a scary diagnosis. But what we are talking about here is pudendal nerve irritation. We actually compare it to something we’re more familiar with - sciatica)

So it’s definitely possible pudendal nerve irritation is driving symptoms. There are many other nerves in the area which can be causing symptoms as well, so that’s where a pelvic PT can both figure out what is going on and work to address the issue.

This also explains why many people with IC-like symptoms are given bladder-focused treatments (bladder instillations, Elmiron, hydrodistensions, etc.) without benefit.

Finding Pelvic Sanity Facebook Group

If you haven't already, make sure you join the Finding Pelvic Sanity online support group (www.facebook.com/groups/findingpelvicsanity). It's a supportive group and moderated by the PelvicSanity team, so you know you're getting high-quality information.

If you're local to Orange County (or can come here for treatment), we would love to work with you directly!

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

Have you heard or been told you 'just need to Kegel'? Here's why that's never the answer to pelvic health issues.

Kegels (or the voluntary squeezing of the pelvic floor muscles) are often one of the only areas of pelvic health we’ve heard about. It’s often surprising to people to learn Kegels are often ineffective, antiquated and can cause flares or actually exacerbate symptoms. Here’s why they are rarely used at all at PelvicSanity.

1) The majority of people with pelvic floor symptoms already have overactive pelvic floor muscles.

This means we want to be working to calm down the pelvic floor. Help it to relax and stretch out. Not adding a bunch more work for it to do!

Not only are Kegels ineffective, but can often flare symptoms for those with an overactive pelvic floor. This is why Kegels are never recommended for those dealing with pelvic pain.

2) Even if you are weak, Kegels aren’t the best way to strengthen the pelvic floor.

Even for the small subset of people who truly do have pelvic floor weakness, Kegels are only one small part of the pelvic floor.

If your goal is to run without leaking, how is laying on your back and staring at the ceiling the best way to train for that? We need to get you up off the table and get your pelvic floor working in a functional manner again.

3) Kegels don’t find or resolve the underlying ‘why’

At PelvicSanity we’re always about trying to find and address the root cause of your issue so it doesn’t return.

The underlying why is usually outside the pelvic floor - in how you’re moving, in your back, or glutes, or hips, or ankles. Unless we find and resolve the underlying why, symptoms will either return or crop up in a different way in the future.

So if your pelvic PT was only doing Kegels or biofeedback, make sure you find a great pelvic PT for a second opinion. And if you haven’t been to pelvic PT yet, let this be your call to action!

Local to Southern California?

Our expert team in Orange County would love to help resolve your pelvic floor issues for good - without a bunch of Kegels or biofeedback! Give us a call or send us a message and we'll be happy to answer any questions and get you started!

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

Why do most specialty pelvic health clinics see patients for a full hour, 1:1 with the therapist?

Ultimately it’s so we have time to ‘find the why’ for actual relief. If you aren’t working with a qualified pelvic PT to ‘find the why’, one of three things happens:

1. You don’t improve at all
2. You see little, temporary improvements that don't 'stick'
3. Symptoms do improve, but end up cropping up somewhere else

For most patients in pelvic floor physical therapy, internal evaluation and treatment of the pelvic floor muscles is extremely important. This takes time and can’t (or shouldn’t be) rushed.

Then we have to evaluate and treat the external contributing factors. In fact, most of the time the ‘why’ is found outside the pelvic floor. So we have to have time to treat externally in each session as well. This could be treating the low back, mid-back, neck, hips, knees or ankles, depending on where the issue is coming from.

If your PT is only looking internally at the pelvic floor, or only looking externally at the orthopedic issues, they are missing half the picture.

The reason many physical therapy clinics don’t see you for a full hour is so they can make more money from the insurance company. Financially, it doubles the clinic's revenue to have a PT seeing two (or more) patients per hour. They do this by using aides, having someone watch you exercise or adding billable time with ice or e-stim at the end of your session.

Most specialty clinics reject this model. It might be helpful for simple orthopedic issues, but it certainly doesn’t benefit patients with complex pelvic floor dysfunction. And even though it might be more lucrative to rush patients through the door every half hour, most experts aren’t willing to compromise on the quality of care.

So if you’ve been seen at a clinic for less than an hour, or had your PT seeing multiple patients at the same time, don’t give up on pelvic floor physical therapy!

Local to Southern California?

If you're local to SoCal, give our team a call and let us help you find lasting relief! And if you aren't, we offer a remote consultation program to get a second opinion on your case.

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

If you (or someone you know) has had a C-section, make sure to listen to this full 'sode!

As anyone who has had one will attest, a C-section is a major surgery. And in the US, almost 1 in 3 give birth via a C-section. But we are so cavalier about recovery!

After every other major surgery you are immediately referred to physical therapy to aid in the recovery. Make sure the wound heals correctly. Ensure the scar moves smoothly. Get back your range of motion and strength in the area.

Except for C-sections (and other pelvic and abdominal surgeries). There we just tell you to try and 'take it easy' (while dealing with a newborn) until it heals and hope it does well.

A C-section scar can be a major driving factor of pelvic floor and abdominal issues.

It sits right above the bladder; if your scar is 'stuck' or adhered, it can make filling the bladder more difficult and contribute to urinary urgency/frequency.

The muscles of the abdomen are intricately connected to the pelvic floor and the low back. A history of a C-section can drive low back pain and ultimately pelvic pain.

We believe every person who has a C-section should be seen by a pelvic floor physical therapist to ensure they have a full and complete recovery.

The good news is that no matter how long it's been you can still get help! If you have other symptoms, make sure your pelvic PT is checking your C-section scar. It should move and feel almost identical to the tissue around it. It shouldn't be painful to touch or move or numb. And if you have an aversion to touching it (or even looking at it), definitely a sign to see a pelvic PT and get it moving freely again!

Remote Consultation

If you're struggling to get answers from your local practitioners or aren't sure what's next, PelvicSanity offers remote consultations to give you a concrete action plan going forward. Our expert team will evaluate your entire case and give you our honest, clear recommendations going forward. Check out our Remote Consultation program (www.pelvicsanity.com/remote) for all the details!

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!