The Power of a Proactive Approach to Pelvic Health with Dr. Hailey Miller PT, DPT

As part of our Expert Spotlight Series, Lauren chatted with Dr. Hailey Miller, PT, DPT, is a pelvic health specialist, physical therapist, and co-creator of Move Through Motherhood, a program supporting women through pregnancy, postpartum, and beyond. With a decade of experience in fitness, physical therapy, and holistic healing, she specializes in pelvic health for all ages, driven by her own journey with prolapse, diastasis recti, and pelvic floor recovery.

In this chat, Lauren and Dr. Hailey discuss how this often-overlooked aspect of health is key to overall well-being for women at all stages—from pregnancy to menopause. Dr. Hailey shares her wisdom on how pelvic health impacts everything from posture and stability to emotional wellness, and why addressing issues like leakage or pain shouldn't be dismissed as "just part of being a woman."

Check out five highlights of the conversation below, or watch the full chat on YouTube!

1. Listening to your pelvic floor to better understand your body’s needs

Lauren:

For someone who maybe is newer to pelvic health or doesn't know a lot about it, how do you explain the importance of it?

Dr. Hailey:

I would say your pelvic health is the key to your health in general. It's like your foundation. I typically tell people if something is off in your body, your pelvic health usually tells you as long as you're listening and knowing what the signs and symptoms to look for. It's kind of like the key to how your body is functioning. It's kind of like our indicator of our bowel, bladder, and sexual health function, our stability and posture, and also our circulation and lymphatic system health. So if those are off, even if you're stressed, the pelvic floor will respond. It tells you everything. Some lifestyle indicators like stress, nutrition, movement, or if you're not moving well--your pelvic floor will definitely respond. If there's structural stuff going on, it definitely will give you some signs like pain, pressure, that kind of stuff.

Lauren:

I like hearing you say that. I think it's interesting how tightly integrated it is with our whole body system, that physical, mental, emotional, and yet a lot of people don't know about it. And so as you start to learn about it, you're like, "Oh my gosh, this low back pain, it's all related!"

And I've seen stuff recently with connections to your feet and things like that. I think it's really fascinating how interconnected it all really is. For me, it's one of those things where you hear a word that you've never heard before and then you're hearing it everywhere--that's kind of how it can be for folks with pelvic health and pelvic floor. They may have never heard that before and then all of a sudden it's everywhere.

Dr. Hailey:

That's for sure. I know if you say something in a room and your phone's there, you're going to get all the ads and targeted reels on it.

2. You don’t have to accept that you’re “just going to leak after you have kids”

Lauren:

What are some of the biggest myths or misconceptions that you come across that you feel like we really need to work to address and educate on?

Dr. Hailey:

Oh man. From a broader perspective, we hear a lot of things like, "Oh, that's just part of motherhood. That's just normal to experience as a woman." Any pelvic floor dysfunction is dismissed and thought of as being normal and part of being a woman, and it's not true. All that stuff is common. It shouldn't be normalized at all and there are so many things that you can do to help with it.

Leakage is one of the most annoying myths, like, "Oh, you're just going to leak after you have kids." But some people even leak when they don't have kids. They're probably not getting this information from a good source or they just haven't been educated on pelvic health and how everything is interconnected and how different systems influence your pelvic health.

Lauren:

That's such a big one and I think it's helpful to hear that because I think sometimes new moms, and really just women in general, put up with a lot before we'll go and seek help for it. So I think it's helpful to hear that while these things are common, there are things that we can do about it to help because so many of them drastically impact quality of life. And so while your immediate reaction might be like, "Oh, well this is just how it is, I'm just going to put up with it and put all these other things into place to deal with it," know that there are tools and resources to help if something's bothering you, and it's really worth your time to try and figure out if you can help remedy it versus just dealing with the symptoms. Because I think more often than not, there's something that can be done and I think that's important.

3. A simple, one-second daily habit to improve your pelvic health

Lauren:

So I know of course pelvic health is very unique to the individual, but can you share with us some general habits or best practices that can be applicable to a broader population?

Dr. Hailey:

Yeah. I would say maybe some habits would be not gripping certain parts of your body and just checking in with yourself. Are you clenching your jaw? Are you tensing your upper traps? Are you tucking your booty under to hold yourself up or even your toes--are you gripping and curling your toes in your shoes to find stability?

Breathing is a really important one. I think that's something that I go over with everybody who comes into my office (and even not in my office, just day to day). I'm like, "You should take some deep breaths. Let's breathe and learn how to breathe because that rib movement will help that spine move and the sacrum move and the organs pump as you breathe in and out. It also helps with stress and focus and sleep." So breathing and just body awareness. What are you doing? What is your body feeling like? And just checking in throughout the day. Those are my top two to help with everything.

Lauren:

I feel like folks should be able to easily relate to those, and it's ones that when you do start to pay attention to them, it makes a difference. I know the clenching and the tension is one for me. It's one that you just don't think about, you didn't realize, and then once you're made aware, you're like, "Oh my gosh, I'm doing that all the time." And so having that reminder to relax those muscles and let the proper ones take over is really impactful.

4. Proactively supporting pelvic health through every stage of life

Lauren:

Will you talk to us a little bit about how pelvic health comes into play? We could focus on women at different phases of their life. I know for a lot of folks, it's not until maybe postpartum and something's gone wrong that they might be introduced to pelvic health, but I think having that more proactive lens and then understanding how it can come into play over the course of someone's life could be really helpful. So I was hoping you could talk to us about that.

Dr. Hailey:

Oh yeah. I usually start with childhood stuff too. So women with history of chronic constipation or history of gymnastics or lots of athletic sports, that impact and that tension that they've just developed, that mindset of performance and competition, that definitely tells you what that person's body is going to feel like. So for younger adulthood, tension and lifestyle management like nutrition, sleep, stress, just your basics will influence your pelvic floor health. If we're on the go, not drinking water, not eating well, not mobilizing well, we're typically going to develop some kind of pelvic floor tension which could present as back pain or hip pain. That's where pelvic health therapy can come into to show you what to do and how to change your life a little bit just to help you in the future avoid future pelvic floor dysfunctions.

I would say another area of life that's not talked about is perimenopause. It's something that we are not really aware of and I think it's happening earlier and earlier because of our lifestyle, our food choices, and our stress and our culture of being on the go all the time and not slowing down. I see a lot of pelvic floor dysfunction with pain with intercourse or any type of penetration. And then just perineal pain, vulva pain, sometimes the prolapse symptoms and just vaginal dryness and all the other stuff that come along with hormonal changes. There's so much more to hormones that we aren't really educated on in the public view.

And then menopause, there's a lot of pain with intercourse that we don't talk about, and vaginal changes, vulvar changes, and just overall musculoskeletal changes that we don't address. We should be working on all of these things before these stages of life.

Lauren:

I think it's helpful to hear for all of these different milestones, the different things that can come into play; one, so you can be more mindful of them, and then two, to the extent you can get ahead of it. I feel like more awareness is better to help folks understand how things can change over time and what you can be paying attention to and be proactively working on.

5. The impactive of proactive pelvic health care for moms before and after birth

Lauren:

Will you tell us a little bit about what you find as some of the most rewarding parts of the work you do?

Dr. Hailey:

There's so many. I think my most favorite is seeing moms after they've had a really difficult pregnancy the first time and they didn't go to pelvic floor PT, but I get them after they've had their first kid and then taking them through pregnancy and showing them how they can enjoy it and move without pain and just enjoy their pregnancy a little bit more.

But more importantly, the labor prep and postpartum prep during pregnancy is game changing because after they have their baby, their body is just more prepared to heal and recover because they've done all the work beforehand so they can enjoy postpartum more. They have all the tools and the resources.

I also love educating on infant care and what you can do to help with all that stuff so that mom and baby are more successful afterwards. So even if she's dealing with pelvic health issues like leakage, tailbone pain, or prolapse symptoms, she can have those resources and tools before she experiences them so she can know what to do with her baby and her kids.

Lauren:

I love that piece because I think that knowing about it before you experience it can also help so much mentally. For me personally, thankfully I had good resources in place to work with the pelvic for PT after the birth of my first kid, but I was still completely blindsided by my prolapse diagnosis. And my postpartum experience the second go around compared to the first was a night and day difference. I think a huge part of that was just knowing what to expect. I know what these symptoms are and I know what this road looks like. It's so impactful to understand what can be going on and then what you can do about it versus "Bam, this has happened, and then what on earth am I going to do?"

Dr. Hailey:

Yeah, I would agree with that. I have a lot of moms who come after their first kid and they're like, "I have all these crazy symptoms and pain, and my midwife or my gynecologist said, 'oh, that'll get better with time.'" But they're struggling and they come in so defeated and so hyper aware of all their symptoms that they can't truly enjoy being a mom and where they're at in that life.

My first pregnancy was rough, and then the labor was fast, so my baby came out in under five hours. It was very intense and I got to experience the uncomfortable prolapse symptoms and I was just like, "Why is this happening to me? I should know how to help with this." But it took me a long time to recover, even as a pelvic floor therapist, I was like, "What am I missing?" And it wasn't until I looked outside my pelvis to my feet that things went away. It was crazy. It was like, you can't PT yourself. That's the thing. You have to have other people to help you check in with your whole body.

Bonus: “The most magical therapy ever”

Lauren:

Is there one thing that you wish that everybody knew about pelvic floor health or you feel really passionate about?

Dr. Hailey:

I think it's the most magical therapy ever. Pelvic health therapy can really help with everything, because it's not just the pelvis that we're looking at. It's literally how it's all connected head to toe, inside and outside, and if you've just been experiencing weird symptoms or weird pains that just aren't addressed with normal stuff, go see a pelvic health therapist because they're usually going to explore inside and outside to figure out where it's truly coming from. It truly is amazing and magical because it can help with a lot of issues.

Lauren:

I'm almost three years postpartum with my second, but I've kind of shifted into this mode where I'll still see my pelvic health PT annually, and I just kind of pair it with my OB appointment. I'll be like, "okay, I'm going to that one." I also like to see her because they're addressing two very different things, and then it just helps me keep that relationship up and just kind of stay in tune with how things are going, and so that's been a helpful approach. Keeping in mind how important this is, and if you can, not only go for help when you have an issue.

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