Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hello everyone, and welcome. I’m Dr. Krystal Lynn Couture. The pelvic acu. And before we get started, I wanna say a special thank you to the American Acupuncture Council for hosting this vlog. If you haven’t been to the American Acupuncture Council website, you absolutely should go there because there are amazing vlogs like this one that are filled with little nuggets of gold for acupuncturists and.

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They do a really nice job of sharing those teachings in little bite-size bits. So let’s get started with today’s workshop. We are going to be talking about postpartum and the pelvic floor. I. So what’s inside our workshop today? We’re going to be talking a little bit about sitting the moon or sitting the month.

We’re gonna talk a bit about miscarriage and abortion. We’re also going to have a chat about some postpartum challenges that moms could encounter. We’ll talk about the healing process that one goes through. Through the postpartum process. We’ll talk a bit about the hormones, we’ll talk about the perineum, and we’ll talk about uterine involution.

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So here we go. Alright. Sitting the moon or sitting the month, lots of cultural traditions, including Chinese tradition around the globe, suggests that the mom and the baby really spend the month or the moon. Being protected, being nurtured, being nourished, bonding, and recovering with each other. That means there’s very little demand.

On the mom and on the baby, except for healing and coming together in harmony with each other and the outside environment, right? Western tradition suggests that recovery period postpartum after childbirth, there’s an acute period of 24 hours, a subacute period of 24 hours to six weeks, and then a delayed recovery period, which is six weeks to six.

Months. And so there’s a difference in how Western terminology and how Eastern terminology looks at the postpartum recovery period, and what is encompassed within that. So let’s get into sitting the moon. The traditional recommendations are lots and lots of rest for the mom, and this is really bed rest including 10 hours or more of sleep per night.

The body has just been through an immense transformation and a major outsourcing of. Energy or expression of energy, right? So rest and sleep are really important. During that first month, it brings in the support of family members, friends and nurses to maintain the cooking, the cleaning, and other household tasks.

It’s really not part of traditional culture that these things are done by the mom while she has the new baby at home. Another part of sitting the moon that is done in traditional cultures is abdominal binding, and that’s really to help reduce the laxity in the abdomen and restore the proper pressure.

Within the abdominal cavity. And we’ve talked a little bit about pressure within some of our workshops here, right? So the abdominal pressure directly impacts the pelvic floor pressure. Now you can imagine after the birth process that the pressure change is going to be pretty significant.

Abdominal binding helps to bring that pet pressure. Back to a normalized state, and it’s also going to help with the pelvic floor healing as well. And of course, eating and nourishment are going to be such a big part of this sitting the moon period. And also of course, for milk production, right?

We wanna make sure that moms are getting the right nutrition into their body. That’s going to be satisfying, that’s going to be nourishing, that’s going to fill the coffers with what might have been depleted. During the pregnancy and then during the birth. But of course, it’s also important to remember that balance, right?

So not eating too excess is another important facet to the postpartum dietary kind of idea. Okay. And then of course, maintaining warmth in the body, right? As Chinese medicine practitioners, it’s very rare that we recommend cold. We tend to go toward warmth. Warmth is particularly important for new moms postpartum.

It continues to help to support the movement and the consolidation. Of the qi, right? So again, it’s that harmonization. What is too much, what is not enough? Let’s balance that out and the right types of warmth are going to be supportive in that way. Okay, let’s talk about some of the traditional restrictions that are going to be part of sitting the moon in Chinese culture.

And these would include washing one’s hair. We know that is a restriction as well during menstruation. It continues, of course, into postpartum. Bathing avoiding a draft is gonna be really important. Lifting, especially lifting the baby. And in traditional cultures, actually even, so I’m Italian and looking back into Italian culture, this is also a, a philosophy there as well. So it goes across the sort of folklore and the tradition of medicines around the globe. So lifting the baby, all that weight can help and support the mom’s poor posture, right? So we have this laxity in. The body after the birth, right? So the abdominal muscles are stretched and they’re weak, and generally there’s this forward tilt of the pelvis, which means the back muscles are tightened and those glute muscles are stretched.

So there’s this imbalance, and until that balance is restored within the body, whenever the mom is doing lifting, she’s facilitating. More of that poor posture. So lifting whenever possible is something that should be done by the nurse, by the family members, by community. And I think that’s the biggest key when we’re talking about sitting the moon and cultural tradition, is that community is such a big part of these traditions.

Where in Western society it’s almost mom’s gotta do so much. By herself and if she’s lucky, dad gets, a period of postpartum time as well. So dad can help a little bit, but it’s really leaning into community is so helpful. So as acupuncturist, if we can provide our clients with resources for accessing community for our postpartum moms, that’s such an amazing asset.

Okay. Another thing, climbing stairs, again that contributes to poor posture and also too much load on the body and change in the abdominal pressure. Nursing in sideline position is so important. Any watching TV reading or. Now we say scrolling as well. This is all going to be things that take the mom’s energy or put in energy that is going to impact what she is sharing with the baby, right?

And also shedding tears. And of course, we all know the Chinese proverb that says one teardrop from a postpartum women is worth 500 kilograms of gold. So just keep that in the back of your mind and share that with your clients. Let’s talk about miscarriage for a moment. Miscarriage is considered to be more serious than childbirth, according to Giovanni Macha.

And this is also true in a lot of the traditions, right? So women who’ve had a miscarriage or in abortion for that matter, the postpartum cycle could actually be extended. And the reason for this is because the natural cycle of pregnancy. Is interrupted, it is changed. The body has an expectation to complete a cycle when it is not going to complete that cycle.

That is a huge interruption in the cycle, in the energy of the cycle, and of course within the hormones. So not having completed the cycle can create quite a struggle within the body, mind, and spirit. Let’s look at some statistics here. Postpartum complications from a 2024 study actually showed that 35% of women experience pain with sex.

32% experience, low back pain, 31% experience urinary incontinence, 34% anxiety. 19% experience rectal incontinence, 15% experience pain I’m sorry, fear of childbirth. 11% peroneal pain, specifically 11% secondary infertility. Prolapse is 1.4 to 13.7%. So those numbers were a little bit varied depending on where the study was looking.

And then that’s with a vaginal delivery with a c-section. The prolapse is were 2.4 to 21.2%. So there’s a lot of variation there and that’s something I think that needs a little bit more research. But as you can see, there are pretty big. Statistical indications that show that there are a lot of postpartum complications.

And as acupuncturists, guess what? There are a lot of ways that we can support our clients, especially if we specialize in pelvic care, postpartum depression as a complication. I gave this its own slide, so in 2009. 2010, there was 9.4% of women reporting postpartum depression. In 2021, that number jumped by 104% to 19.3% of women.

Now, of course, during this time, there was the covid, so that was part of it. Also, women are talking more about what’s happening in their bodies, right? Women are starting to be more and more aware of what’s happening. This increase was noted across all races and ethnicities. There was also a substantial correlation between postpartum depression and obesity.

So these are all important things for us to be aware of with our clients. Okay, so I’ve included this chart for you to have a look at. You can go ahead and pause here if you like, to look at this interplay between the intrinsic and extr extrinsic predispositions to pregnancy, labor and childbirth, and medium term and long term maternal complications.

And you can see that these go out long after childbirth that we can still be seeing. Complications, which include prolapses and that sort of thing. So what does it take postpartum to heal, particularly to heal the pelvic floor? I shared a little bit of this slide in our pregnancy workshop, but we’re gonna go into more detail here.

First off is organ alignment and function. If you watch my pregnancy presentation, you know there are major changes within the organ systems in the body during pregnancy, which means that the body kingdom. Is out of order. There was a renovation that happened within the Body Kingdom, and that’s okay.

That’s not a bad thing, but balance needs to be restored. We need to help moms to find proper alignment and of course, utilizing the meridians. Is going to help those organs to come back into balance within the whole of the body kingdom. Now, the uterus size and position, we’re gonna talk about this more.

There are major changes that occur with the uterus size and position. It needs to expand, it needs to move up in the abdomen during the pregnancy, and now. We want the uterus to go back to size. I talked a little bit about ab abdominal binding as a strategy. That’s one way for sure, but there are also other ways that the body can naturally support itself in the uterus responding.

To its natural size and position. Then there’s the perineum that requires healing. There’s the ligamentous and joint recoil and positioning. All those ligaments in the sacrum and the hips and the back have stretched out. Why? They needed to support a baby and then they needed to push a baby through, right?

So we needed space for that. So that recoil. Needs to happen. The fascia, the diaphragms, and the postural alignment, there is going to be a whole new systematic alignment of the body that’s going to occur postpartum. I. Now if moms are not in a state where they’re able to take care of themselves, it’s really hard for that ligamentous recoil and those fascia and diaphragms to align and the posture to be appropriate for our clients through the postpartum phase.

And then, as it’s harder and harder to get it back as time goes on, right? What we have to put in is a lot more. The muscles of the abdominal the abdominal wall, the back, and of course the hips and the pelvic floor, they all went through changes as well. They were all stretched or tightened, so they need to return to some sort of harmony.

Okay. Blood and fluid leveling. We know about bloods and fluids in Chinese medicine. This is a big part of what we do. There’s a lot more fluid in the body when one is pregnant and then there’s a change in that fluid, so that’s going to be a pressure equalization once again, that occurs and it needs to be right.

For where the body is and what the body is going through. For example, a mom that’s nursing is still going to have an increase in fluids, different fluids, different energy, but they’re still going to have that increase. So we’re looking for the harmonization of where they’re at that moment. And then we’re looking at the energetic flow and the meridian flow, and then we’re looking at emotional harmony, right?

So there are a lot of things going on with postpartum moms. We talked about hormones in just about every one of our workshops here. We’re gonna talk about ’em one more time so we can see that at birth we have an increase in progesterone, estradiol, and cortisol. Those and those are all going and placental tigen.

So those are all going to increase. They’re gonna spike at the gradually increase and then peak at. Birth, and then they drop right off. That is a major change. Then we see oxytocin and prolactin come in and they have these peaks and valleys. These peaks and valleys are going to be impacting what is happening in the mom’s body and how her healing process is going to occur.

So when do hormones return to normal after childbirth? Okay. The common response is that, you’ll hear from your western doc is within six months, hormones return to pre-pregnancy levels. Period. Done. Okay, great. In theory except there is very little evidence-based research on postpartum hormones.

In a timeline form, there is research on postpartum depression being linked to decreased progesterone and decreased estrogen. There are studies beginning to emerge that show women who give birth at an older age may have different hormone responses. So basically what we’re saying here is there’s a lot of questions.

Each body is different, and I think when we’re able to transparently answer that question with our clients so that we’re not setting them up for an expectation that may not be reality, I think that’s when we’re going to be able to come in. With our compassion, with our knowledge, with our awareness, and really support them through the process and say, each experience is individual.

Your experience is your own experience, and here’s what we’re gonna do to help you in your process based on what in your clinic. Okay, so estrogen muscles. Let’s talk about the healing process. What we know is estrogen preserves muscle mass. It supports muscle repair. It helps muscles to generate force.

It increases collagen content. It plays a role in muscle metabolism, and it presents muscles against apoptosis. Okay, what we see, remember that gradual increase of estrogen and then that estrogen drops off after the birth right? So we are going to be in a diminished state of estrogen while the body is trying to recover those muscles.

The sudden decrease in estrogen can create decreases in muscle suppleness, strength, power, recruitment, and function. Of those pelvic floor muscles, and of course the abdominal muscles, the back muscles, all the muscles of the body are going to be impacted. But the pelvic floor in particular, because that is where the baby had to find its way through, now talking about progesterone, what we know about progesterone, it supports muscle relaxation. It supports protein synthesis within the muscles, and it maintains connective tissue elasticity. And what happened to progesterone? Same thing. We had that gradually increase and then a drop off. The sudden.

Decrease in progesterone can contribute to muscle weakness, proprioceptive confusion, and stiffness within the tissues, right? So we’re really at a disadvantage. The body is at a disadvantage to naturally recover on its own with zero intervention. Zero thought about the pelvic floor, zero thought about the abdomen.

The perineum tears occur in 80 to 90% of first time moms. A first degree tear is just the skin being impacted. Second degree impacts the skin and the muscle. Third degree is going to be a tear that includes the skin, the muscle, and it’s a partial tear of the external anal sphincter. Fourth degree includes the skin, the muscle, and is a complete tear of that external anal sphincter.

Now an episiotomy is when they do a surgical cut to try to control the the tear or to expedite the birth sometimes they’re done in emergency situations, sometimes they’re done to prevent serious tearing. The research on whether or not an episiotomy actually can prevent. Serious tearing is questionable at this point.

There is not good evidence to show that. That’s a topic for your client to have conversation with their midwife or their OB about. The stretching and expansion of the perineum is a natural process. The perineum will start to expand at the end of the pregnancy. That’s a good thing.

We want the perineum to expand. That’s going to help the process. Two to eight weeks after the birth, depending on the stretch and the tear. Intensity. The perineum generally starts to return to its pre-pregnancy state, to its unstretched state, and of course that varies significantly based on whether or not there is tearing.

There is some evidence that’s coming out, that perineal massage, that breath work, that relaxation can all really help with reducing the risk of perineal tearing. Now of course if the perineum does tear, that’s another implication, right? For what we have to do to address the pelvic floor. Okay, let’s talk about uterus, involution really quickly.

Okay, so this is the womb. Returning to its pre-pregnancy shape and size, involution begins as soon as the placenta is delivered. So basically the body just doesn’t get a rest. It does not get a rest. It goes through this pregnancy phase, which is a lot. It goes through the birth, which is an extreme amount of energy, and then the placenta is delivered, and then the body is oh, okay.

Now we start. Now we start again. So it’s the next part of the process. It’s that return as the uterus contracts to deliver the placenta and subsequently continues contracting, right? It starts to decrease in size. That contraction with nothing there to hold the shape kind of makes it start to shrinking.

Process. Involution, they say, takes about six weeks total. With more oxytocin in the body from breastfeeding, they say that the involution actually takes a little bit less time. Signs of involution include the Lok qia discharge, and of course postpartum cramping and contraction. Now pelvic floor muscle recovery postpartum.

A 2022 study found that at 12 months postpartum falling of vaginal delivery. The pelvic floor muscles are not yet fully recovered compared with their mid pregnancy values. Okay, so that’s not even talking about their pre-pregnancy values, that’s talking about mid-pregnancy values. This number should be concerning to you as a healthcare provider.

Some contributing factors that we see here are going to be a vaginal delivery, of course, versus a c-section tearing or episiotomy the size of the baby, difficulty of the delivery. What we know about the pelvic floor muscles is that it takes six to 12 weeks to build muscle. Muscles do not build themselves, so that means that it takes effort working with the pelvic floor to restore harmony.

And to restore balance. So where do we come in as acupuncturists? As acupuncturists, we have some amazing tools within our toolkit that can really support clients. And these tools are of course going to include using TCM. To help rebalance the patterns in the body and restore and nourish the system.

We, of course, have herbs that will do the same or whatever else is needed. We have moa, which really helps to consolidate and warm and activate blood flow within the muscle tissues. We have our gua, we have cupping, which, you know, cupping a little bit. Perhaps questionable considering there might be depletion, but it could be helpful in an isolated spot if there is particular tightness and over contraction.

For instance, if we have that imbalance that I talked about earlier with that serious anterior pelvic tilt and those back muscles are just. Squeeze down. The qls are just really tight. Those paraspinals are really tight and the abdomen is really stretched and the glutes are really stretched.

Cupping on that specific area could help to reduce the excess that’s in that area, distribute that throughout the body so that we can achieve a little bit more of a neutral tilt. We also have things in our tradition that are from the deep traditions of Chinese medicine, like pelvic steaming, like pelvic smoking.

Like abdominal binding, right? There are a lot of complimentary techniques that we can use to support our clients. Beyond that, if we get to know the pelvic floor in a deep way, then we’re gonna have the opportunity to support the pelvic floor, to evaluate the pelvic floor to. See where there are weaknesses to see where there are excesses, to see where we’ve got, stretch and tightening, right?

Because the left side and the right side might be different. Maybe the person who was having her baby had a leg length discrepancy, so everything on the right side, including the pelvic floor, is really tight. And then maybe there was a little tear going toward the left, and the left side is super duper weak.

So helping us to expand our practice by understand the pelvic floor really helps us to support these postpartum clients. So if you are with me today you probably know that this is my fifth workshop In my series we did a pelvic floor intro. We did a pelvic floor and menstruation, pelvic floor in fertility, pelvic floor in pregnancy.

This is pelvic floor and postpartum. We’ve also got a pelvic floor and menopause workshop coming up for you. Here are some references. I just wanna say, once again, thank you so much for being here. I really hope you enjoyed this workshop as much as I enjoyed sharing this material with you. Once again, I’m Dr.

Krystal Couture, the Pelvic acu, and this workshop has been sponsored by the American Acupuncture Council.

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In today’s vlog, we’re going to be talking about one of my favorite topics. The pelvic floor and pregnancy.

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hello everyone, and welcome back. I’m Dr. Krystal Lynn Couture, the Pelvic Accu, and I’m here for another blog. Brought to you by the American Acupuncture Council. If you haven’t popped over to the American Acupuncture Council website, you absolutely should because they sponsor amazing vlogs throughout the month.

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In today’s vlog, we’re going to be talking about one of my favorite topics. The pelvic floor and pregnancy.

In order to really understand what’s happening with the body through pregnancy, I want to talk about the energetics of pregnancy and conception, as well as talk about a little bit of the spirit of the Po, evolution, hormones during pregnancy, the Yuan Chi, Teeny bit about pathologies during pregnancy bodily changes and then the restoration and repair process of The body that it goes through during that pregnancy experience so in the simplest terms when we’re talking about conception is going to be the addition of Yin, and yang Right?

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Yin is going to serve us as those prenatal qi energies and the postnatal qi energies. So therefore we’re going to have the connection of essence and blood. Yang is going to serve as the minister fire. As we go deeper into conception, the mum is going to provide different things. Then the father is going to provide, right?

And in order for them to provide these in balance and harmony, they have to be balanced and harmonized within each of the individuals prior to conception. This is going to lead to the healthiest form of. pregnancy and for the fetus, right? So we want the mom to have the spleen, the liver and the heart in good communication with each other, and also in the perfect balance, not in excess.

Not in deficiency, and this is so that making, storing, and the governing of blood will be harmonized for the pregnancy and for the fetus. The chong and the ren also need to be in balance, and they need to be open for pregnancy. to occur. The chang is going to be that mover of the blood and the ren is going to provide us with that yin.

So we want to see harmonization there. We also want to see the kidney jing in a state of vitality, right? We need the mom to be vital when she comes into pregnancy in order for her to remain vital throughout the pregnancy and after the pregnancy because that takes so much. energy. I also need her to be vital because she’s going to be providing that energy to the baby as well.

I want the minister fire again to not be in excess and not be in deficiency. We need the perfect amount of fire. We want the postnatal chi and blood to be in harmony. Which of course is determined by so many life factors and how one is choosing to exist within their life along the path of their Tao.

And then finally the spirit of the Po is going to come in. From the dad, we need the liver to be in harmony. We also need that vitality from the kidney Jing and of course the postnatal Qi and blood. All of these in harmony and balance are going to contribute to a better life. Successful and bountiful, abundant pregnancy that serves the fetus to the highest and best.

So let’s talk a little bit about the spirit of the Po here. So the Po, as we know, is the corporeal soul. It is the tangible. It is the spirit of the lungs and it resides within the lungs. It is a physical soul. So it has a yin nature to it. It is going to be transferred from the mom. To the fetus, the PO, as we know, is the soul that comes in with the body at birth and it dies at death.

So it does not extend its spiritual journey. It’s corporeal. Thus, the constitution of the baby is reflective, not only of the kidney energy of the mom and dad, but also the mother’s lung energy, right? Spiritual access. Chapter eight says the corporeal soul is the entering and exiting. of essence. And I really love that quote.

And I really think working with the Po is so helpful in the journey to working with moms in their fertility phases. So let’s look at the Kinney Jing evolution. Okay. So during menstruation versus pregnancy that we’re going to have a different experience here. So during menstruation, we know that the kidney gin, it links to the Tian Gui, right?

The heavenly waters, the minister fire acts upon that. And then we have menstruation, right? During pregnancy, that kidney gin is going to nourish the fetus and it’s going to replenish and recycle. The Tian Gui is going to replenish and recycle to Restore and serve that kidney jing. So we have two different pathways of what’s happening with the kidney jing here.

Now we’re going to have abundant yin, right? We’re going to have an increase in fluids with that tian gui replenishing and nourishing the fetus. We’re also going to have abundant yang because there’s no release of that minister fire. So there’s a significant abundance within the body, within the pregnant body.

Also, we’re going to have the component of the energy that travels up the chong. To the breasts also with the stomach chi as well. That’s going to transform blood to milk on an energetic level So this kidney gene evolution is two different stories two very different stories of what’s happening in the body And I think that’s important for us to understand as well as to be able to share with our clients What’s happening on an energetic level in their body when their monthly bleed?

is no longer. Let’s talk also about hormones during pregnancy. So we’ll see that at the beginning of the pregnancy, HCG is going to spike and then it will drop the rest of our hormones. So progesterone, estrogen, estradiol cortisol, and of course our placental actogen, they’re all going to gradually increase to the birth.

And then they’re going to quickly drop off. This is why there are so many Different emotions, different feelings, different experiences throughout the pregnancy process and after the birth, there is a drastic change in hormones. We’ll also see just at the birth, we’ll also see oxytocin spike.

And then we’ll see oxytocin and prolactin spiking and cycling. So highs and lows. And that is when the fetus will be, the baby will be suckling, right? So there are those increases if the mom is going to be breastfeeding. So there are continuous changes of what is happening through the hormone cycle.

Now, if the mom is breastfeeding, there is a chance that the progesterone and estradiol, and even the cortisol are going to stay low, which is going to lead to more emotions as well, which are important to consider. So now Yuanqi in the fetus. Yuanqi is derived from prenatal Jing from the parents at conception and stored in the kidneys responsible for growth development and maintenance of life.

Now I really like this quote that I found in the Shilin Temple blog which describes kind of Yuanqi and the cellular nature. So cell division requires a fixed liquid base of Yuanqi which allows the cell which compromises the yin or essence of life to divide. Weakness in the yang qi, or yuan qi, or weakness of the yin causes the cells to lose its true identity, its dao, and to create chromosomal changes which cause the fetus not to develop in a way that is consistent with the laws of nature which desire harmony.

So basically what this is saying is that even at The basic, most simplest cellular level, the body, the fetus is seeking harmony. It is seeking homeostasis, and it is seeking that in alignment with the Tao, with the purpose. And there’s so much power in that, there’s so much understanding in that, and there’s so much energy that is required during that phase.

Very briefly, let’s touch on pathologies of pregnancy. The first that we’re going to talk about is going to be a deficiency which could be of blood and yin as well as kidney deficiency. Now this is going to be particularly seen in those who have a tendency toward overwork and thus may have a pre existing kidney deficiency.

Could be kidney yang or kidney yin depending on other factors, right? It’s really important for us to understand our clients that are over workers. If they are coming in with these types of deficiencies that likely, unless they make major lifestyle changes, they aren’t going to change during the pregnancy.

So we want to address that. We want to be aware of that so that they can have a successful fertility into pregnancy journey. Another thing that we’re going to see. is rebellious chi and rebellious chi is, it makes sense, right? Because of the physiological process that’s happening within the abdomen, that there’s going to be this upward rising energy where there’s meant to be a downward rising energy.

Now, this rebellious chi is going to impact the stomach channel as well as the Chiang Mai. And these are particularly related to emotional stress. So while there is that physiological component, emotional stress is going to compound rebellious chi. There’s also, again, with what’s happening in the middle here, that middle jiao can be obstructed and cause some spleen chi deficiency.

And the buildup of phlegm again, sounds obvious during pregnancy, but important for us to be really aware of. This is also going to be something that can create some disharmony between the Ren and the Chong channel, which we want the Ren and the Chong to be strong for fertility and strong throughout the pregnancy and afterwards.

So why are we bringing up pathology in this workshop? Really the key here is because I want you to be aware of the contributing factors. that can impact pregnancy and also that might impact the pelvic floor. So we start to think about kidney deficiency, right? And if this leads to our liver yang rising, or it liver win rising, that kind of thing, or An ultimate a deficiency in that Yuan qi that’s going to be an impact on the pelvic floor because of its connection with the kidneys, right?

And the reproductive system, that rebellious qi, that confusion, proprioceptive confusion of upward versus downward energy is going to be difficult for the pelvic floor. rises and falls as well, right? With contraction and relaxation. And so if there’s proprioceptive congestion or confusion in the energy channels, there’s going to be physiological proprioceptive confusion.

So want to be really aware of these pathologies and to advise our clients that are coming in for fertility in. The manifestation of overwork in the manifestation of over stress, right? And how they can really focus on this fertility time, focus on this pregnancy time to be with themselves and to be nourishing their own bodies and their babies.

Speaking of, let’s talk about the body. I’m really excited for this section. So in ideal circumstances before pregnancy, what we’re going to see is that the internal organs and the pelvic organs of the abdomen all share space. There’s no major distinction or separation between the organs of the pelvis and the organs of the abdomen.

The organs of the pelvis and the organs of the abdomen, they work in harmony with each other, and there’s enough space. So there’s no crowding within the body kingdom on a physiological level and an energetic level. Now again, this is an ideal situation, right? If we have a client that has endometriosis or has inflammatory bowel disease or something like that, we’re going to see something that looks a little different.

But for our purposes today, this is an ideal situation. At six to seven weeks of pregnancy, things start to grow a little bit. The uterus starts its growth process and the uterus actually within the pelvis starts to put some pressure onto the bladder. This is why we can see the need for increased urination, increased frequency of urination and urgency of urination.

early on in a pregnancy. The placenta is also developing in this six to seven week phase. At 10 weeks, things begin to change. The ligaments of the pelvis actually start to relax just a little bit and the pelvic joints loosen. So this is going to be the sacroiliac joints, the pubic joints, and the hip joints.

And this can actually lead to some of that. early on discomfort within the joints at the very beginning of a pregnancy. So it’s important for us to be aware of. Now, of course, we can also posit that as the ligaments are beginning to change, as they’re relaxing just a little, as the joints have more space, guess what?

The pelvic floor is going to be impacted as well because there’s going to be a little bit of a stretch on the pelvic floor already. So the tension within the pelvic floor is already starting to change at 10 weeks. At 12 weeks of pregnancy, things really begin to move, right? So the uterus is now the size of a grapefruit and it fills the pelvic bowl.

The uterus rises during this 12 week phase. It starts to rise into the abdomen because it’s too big to just stay within the pelvis. the pelvic bowl itself with all the other organs that are there, right? The anterior part of the pelvis sits upon the pubic, I’m sorry, the anterior part of the uterus sits upon the pubic symphysis.

So the bladder here, good news, yay, gets a little bit of relief. But the pubic symphysis is now going to be carrying the load, which progresses over time, right? So we can start to see this shift into pubic symphysis pain at around 12 weeks or a little bit later. Now, between 12 and 36 weeks, the pelvis starts to shift anteriorly.

So it’s neutral position is here and it starts to tilt forward, right? So that starts to begin at 12 weeks of pregnancy. Now there’s an automatic implication to the pelvic floor here, right? Because that pelvic tilt is changing the balance and the position of the ligaments, the tendons, and the muscles within the pelvic floor.

At 20 weeks of pregnancy, things begin to get squished. The rectum, the sigmoid colon, and the small intestine get pushed up and back. The ascending and the descending colon aren’t generally affected during this phase. The uterus continues to move up and push on that lower abdominal And at this point in time, abdominal strength and muscle tautness really impacted the position of the uterus being more anterior posterior.

So someone that has very tight, either fascia or musculature, or has strong abdominal contraction, the. Uterus is going to sit further back, whereas if the abdomen is weak or it’s slack for whatever reason, then the abdomen is going to push forward a bit more. Of course, there is that play with the abdominal muscles and the pelvic floor as well.

They are so deeply connected. I can’t tell you the number of times, not with pregnant clients, but in general with clients postpartum. Or clients unrelated to pregnancy that I work with the abdominal muscles and we can make a shift in the pelvic floor. Such a cool experience. But moving on without getting a ton of tangent at 21, 28 weeks of pregnancy, things really.

get compressed and the weight distribution actually starts to shift at this point. So uterus expands into the mid abdomen. So it keeps expanding upward and it’s pressing now against the stomach. The load is increased upon the pelvic floor and the posture shifts posteriorly. to carry that load.

So the body literally is shifting back into the heels. Now at this point you may actually have clients that are complaining about posterior fascial chain pain. They’re also maybe talking about pelvic floor pain at this point as well because the pelvic floor is really holding a lot of the load here.

At 36 weeks, things really change. The uterus expands to fill the abdomen. It generally meets up to the xiphoid process and there’s pressure upon the diaphragm. That increased load on the aorta, the heart, and the lungs starts to show up at this point. And the abdominal muscles are really supporting the weight.

They’re working really hard to support the weight of the fetus. The vagina. and urethra at this point start to elongate. And then the perineum actually is stretched and enlarged and it begins to protrude outward. So once again, if we’re talking about the perineum, that’s the space between the external anal sphincter and the opening to the vagina in females.

Now, As that starts to expand, we can obviously make the correlation that the pelvic floor muscles are going to be stretched during this time. They’re going to be stretched to uncomfortable limits. At 40 weeks of pregnancy, the body is preparing for birth, and the head of the fetus lowers into that pelvic bowl.

The bladder, again, is compressed, and the colon is compressed. So this leads to all sorts of dysfunction within the excretory phases. If you’ve been pregnant, you know this. If you’ve been married to someone who’s pregnant, you know this. If you work in pregnancy, You know this, right? The round ligament, the utosacral ligament and the broad ligament are stretched.

So now these deep ligaments of the pelvis are beginning to stretch. Ligaments don’t have the same recoil that muscles do or tendons because they don’t have as good of blood flow. So this is important for us to be aware of because this is also going to contribute to what’s happening in the pelvis and the pelvic floor during the recovery process.

Now, postpartum, the body is going to be seeking recovery. The body, generally speaking, is going to be fatigued. It has just worked really hard for ten moons, right? In order to grow. a baby. So it’s going to be fatigued. It is also going to be stretched. The abdomen is going to be stretched. The ligaments are going to be stretched of the pelvis.

The pelvic floor muscles are going to be stretched. The back may actually be tighter from that weight distribution and that anterior pelvic tilt. The uterus, the vagina, the perineum, and the pelvic floor are going to be expanded, stretched, and potentially weakened, right? If we think about it, if a muscle is at its maximum stretch, it’s pretty hard from its maximum stretch to get contraction, right?

Whereas if it’s at a comfortable place in elasticity, getting contraction and relaxation is a lot easier. So there’s going to be some proprioceptive and kinesthetic changes that are occurring as well. Ligaments in the joints are going to be unstable initially. Everything is open and the organs are in a new alignment, which can lead to a lot of body and energy confusion and hormones.

Guess what? They’re all over the place. They are changing frequently and they’re changing differently in different people. So there are a lot of things going on with that body postpartum. In order to restore and repair postpartum, the organs have to return to alignment and function. The uterus size and position all has to return to its, pre pregnancy stage.

The perineum needs to heal. There’s going to be a ligamentous and joint recoil and repositioning that occurs. There’s going to be the fascia, the diaphragms, and the posture are all going to Balance or not balance. If the proper work and attention isn’t done or if the body is in severe depletion beforehand, the muscles of the abdomen, the back and the pelvic floor are all going to change.

The blood and the fluid will level out. And the energy and the meridian flow also hopefully will realign. And then there’s the emotional harmony. All this to say, and we have a whole talk coming up on postpartum, which is really exciting. But all of this to say, the body is going to try to do all of these things on its own.

Why? Because it is always seeking homeostasis. The body wants balance with the body. The Dow, the body wants to be in balance with your purpose here on earth. So it wants to do these things. Now as acupuncturists, we can help clients to intervene in this process and to facilitate the healing in all of these, in all of these phases, right?

There’s more than nine, but I just listed nine out so we can really do an amazing job to support our clients with the. Restoration, the recoil, and the return to their pre pregnancy state. Now, if you’ve been with me and the American Acupuncture Council before, you know that I have previously recorded a pelvic floor intro, a chat on menstruation in the pelvic floor, a chat on fertility in the pelvic floor, and this, of course, is our pregnancy and the pelvic floor chat.

We’ll also be doing a postpartum chat. And a menopause in the pelvic floor chat. So I can’t wait for more time with you. And I really hope you enjoyed our time today. Once again, I want to thank the American acupuncture council for sharing this space and sharing this vlog with acupuncturists around the globe so that we can share these teeny tiny little nuggets of wisdom that hopefully impact you, your practice and your clients.

In a positive way. Here’s some references. Once again, I’m Dr. Krystal Lynn Couture, the Pelvic Accu, and I’ve thoroughly enjoyed my time with you today.

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In today’s vlog, what we’re going to be chatting about is the pelvic floor and its connection to fertility.  So let’s get into it.

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  Due to the unique language of acupuncture, there will be errors, so we suggest you watch the video while reading the transcript.

Hi everyone, and welcome. I’m Dr. Kristal Lynn Couture, the Pelvic Accu. My passion is sharing pelvic care with acupuncturists. Around the globe really diving into the sacred medicine of the pelvis and using our unique viewpoints as acupuncturists to treat the pelvis in a holistic manner. This is why I’m so excited that my entire series on the pelvic floor,

and Women’s Health is brought to you by the AAC, the American Acupuncture Council. I just want to take a moment to thank them and share my appreciation and gratitude for the American Acupuncture Council for sponsoring yet another video. In today’s vlog, what we’re going to be chatting about is the pelvic floor and its connection to fertility.

So let’s get into it.

The table of contents for today’s workshop includes chatting about fertility in Western medicine. In order for us to have an interplay with Western medicine as Eastern practitioners, it’s super important for us to have an understanding of what’s happening physiologically in the body. And that means understanding the male and female feedback loops that occur with the body.

the reproductive hormone system. We’re also going to chat about fertility in Chinese medicine, of course. We’re going to get deep into our chat about Tian Gui today, as well as revisit Yin and Yang. We’ll have a look into the differences between Eastern and Western philosophy when it comes to looking at fertility.

within our clients. We’ll also look at the connections or potential connections between the pelvic floor and fertility. And we’ll look at a couple of studies and perhaps ask some questions that could infuse energy into future studies. And then finally, we’ll chat about how to provide support to your clients that are coming in now with potential pelvic floor and fertility issues.

So here we go. Let’s begin with fertility in Western medicine. As I mentioned, in Western medicine, we’re really dealing with the hormone reproductive physiology, which is really determined by the hypothalamic pituitary gonadular axis and the reproductive hormones, of course. There are both positive and negative feedback loops in females and in males.

The stages of conception include the healthy sperm production, high quality egg production, and high quantity egg production, successful transport during ovulation of the egg to the fallopian tubes, transportation of the sperm to the fallopian tubes, and then of course the sperm penetration of the egg, which would yield fertilization, and then finally that implantation of the fertilized egg.

into the thickened uterine lining. Okay. So let’s begin with these feedback loops. They might be a little confusing when we first have a look at them, but the key is to remember that whether a female or a male body, we are looking at this relationship and interplay between positive negati positive feedback loops, which encourage stimulation, and then negative feedback loops, which are the inhibition.

So let’s get our bearings around us. First off, GnRH is gonadotropin releasing hormone. This is released by the hypothalamus to stimulate the anterior pituitary gland. So you’ll see in green on your screen, the hypothalamus followed by the anterior pituitary gland. What happens here? in the first phase is that the pituitary hormone, inter pituitary is going to release luteinizing hormone and follicle stimulating hormone to stimulate spermatogenesis and testosterone secretion by the testes.

Great. Everything is in balance, right? But the body has a natural system. The body is always seeking homeostasis. And this is actually something I learned in school in Western medicine before I learned it in Eastern medicine. The body always wants balance, right? If your ankle is off on one side, your hip eventually is going to go off or your knee in the opposite side, because the body is seeking homeostasis.

Balance. The same is true of hormones. So the body in males has a natural negative feedback loop which halts the overproduction of testosterone and the overstimulation of spermatogenesis. So in this negative feedback loop, what we can see, so that’s marked by the red on the side of your screen, is that we have inhibin and we have testosterone, which are going to inhibit the secretion of GNRH to hypothalamus.

And then the, that will then, of course, inhibit LH and FSH by the pituitary gland. We also do have a little micro, feedback loop, which is that the Leydig cells will also stimulate spermatogenesis within the testes. So this is the basis of what the male feedback loop looks like in relation to hormones.

And we’re really looking here at a quantity game. We’re looking at the perfect quantity and that’s why we’ve got positive in the negative feedback loop. In females, the feedback loop looks similar, but it is slightly more complicated in that we’re not just looking at a perfect quantity, we’re also looking at the cyclical nature and that’s based on what the uterus is doing, right?

So again we have our hypothalamus, we have gonadotropin releasing hormone Then we have the anterior pituitary and then of course in this case we have the ovaries and the follicles and the uterus and endometrium. All are part of this hormone feedback loop, right? The endocrine system. The pituitary, the Gland is going to release LH and FSH, so luteinizing hormone and follicle stimulating hormone, to stimulate several follicles to grow during that follicular phase, right?

Pretty, it’s named pretty aptly actually. So luteinizing hormone, follicle stimulating hormone, several follicles begin to develop within the ovaries. Check. That’s our positive feedback loop in this phase. of the menstrual cycle. The negative feedback loop in this phase is that the dominant follicle is going to begin to produce estradiol, which is the most common type of estrogen in the body.

This can inhibit the GnRH, FSH, and LH production and this is going to cause the endometrium to begin to thicken. So we can start to see how this process is very unique and Very complex interplay of hormones. A lot of things can go awry here. In our next phase, we have ovulation. During the ovulation phase, we’re going to see that we have two positive feedback loops.

Same system is set up, and and in this phase, what happens is that luteinizing hormone and follicle stimulating hormone actually just stimulate that one follicle That is primary to mature. On the other side of the equation, we have the growing follicle continuing to produce that estradiol. And at this phase it begins to stimulate the G-N-R-H-F-S-H and LH production, and then the LH will serve to promote the.

to trigger the ovulation, right? So we can see that this is an overall negative feedback loop becomes a positive feedback loop. In phase three, we’re going back to a positive feedback loop and a negative feedback loop. So luteinizing hormone in this phase is going to stimulate the formation of a corpus luteum from the follicular tissue that is left behind after ovulation.

Okay, so that occurs within the ovaries. The corpus luteum is going to secrete progesterone, so now we have another hormone in play, and we see, if we look at my last presentation, or any of the hormone graphs that are out there, we can see that progesterone peaks at this time in the cycle, right?

When we have progesterone peaking, this is going to then inhibit GNRH, it’s going to inhibit follicle stimulating hormone and luteinizing hormone production. This maintains the endometrium. As the corpus luteum degrades and progesterone declines, this initiates the sloughing of the stratum functionalis.

So we have a basic understanding of these feedback loops. The key that I want you to remember here, even if you don’t have a total understanding of it or can’t remember it throughout the entirety of the cycle, is that This interplay can easily be jostled, right? We can impact the hormones in the body, we know, by stress, by lack of activity, by lack of proper nutrition, right?

So there are so many factors that can impact any of the phases of the body. this cycle and these feedback loops. Excuse me. Sorry about that. So that’s the key and that’s where Chinese medicine comes in to really have an impact because we come in with our needles and they’re like in our herbs and they’re like little lasers to target the exact parts of the body that need extra support.

So let’s just look for one sec at ovulation to implantation, and we can really see in this image, if we look at the ovary and then into the uterus, we can actually really see that this is about an eight to nine day process from the oocyte being produced to fertilization occurring and then migrating through the phases of cell development.

So we go from that first cleavage to the two cell stage, four cell stage, and we develop over time into the eight cell stage. And then we start to see the formation. of the inner cell mass, and we start to see how that blastocyte is immigrated into the wall of the uterus, right? And that, of course, is the implantation.

So again, this is another complex part of what’s happening in the total picture for female fertility. Now, if we have a look at Chinese medicine we’re looking through a whole different lens here, a whole different world. And perhaps the two uniting is the key to creating successful fertility in women and in men.

Ching Hsu, who’s a gynecologist during the Qing Dynasty, emphasized the unique difference between the blood And the menstrual blood. Blood is traditionally known to Ho House the Hun, and to nourish, of course, the tendons, the sinew, the skin, the eyes, and the hair, the Ian Gu or Heavenly Water. is considered to be the menstrual blood, which is derived from the kidney water and the female hormones of estrogen and progesterone.

The liver is the link between the two. Thus, the tonification of the kidneys is what is one of the most important things to consider when we’re working with fertility in Chinese medicine. Now I made a little bit of a graph here to help explain what we have going on. So if we look at this graph, we can see that we have kidney water and the impact of minister fire activates kidney water to become tian gui.

And then we have the link between tian gui and blood with the liver as the communicator between the two and the connection between the two. So let’s talk about minister fire first. Prenatal fire formed at conception on the du and the ren access. So minister fire actually exists before menstruation commences.

Some texts say that it is the kidney yang that turns the tian gui red. It’s just something to play with there. At 14, the ren opens and the chang flourishes, and this is what matures that tian gui. So the minister fire also serves to worm the uterus and balance the yin. which yields potentially conception.

It’s a pretty exciting process when we really look at it from this viewpoint, right? The Ming Men is the root of the Yuan Qi and the residence of both water and fire. The Yin of the five Zhang cannot nourish without it, and their Yang cannot develop without it. Without it. So what we’re saying here is we have this interplay.

Once again, I’m using that term. We have an interplay of water and fire where fire is not trying to overcome water and water is not Extinguishing the fire. And this is really existing within that role of the kidneys. So our system from Chinese medicine and Western medicine, we see some harmonization here, and we also see different and unique viewpoints.

And these different and unique viewpoints play to the physiology and the energy or the nature of the system. And that’s important to consider as we move forth with our chat here. So in my last presentation on menstruation, I shared this slide of yin and yang, and I’m going to share it again here so that we can remind ourselves of how important the yin and yang water and fire balance is within the body as we look at fertility.

So during the menstrual cycle phase, we have yang at its peak and yin at its minimum, then yang and yin cross, they intersect and the follicular phase begins where yin becomes yin becomes prominent Yang starts to become less prominent. And here we have the ovulation phase when each of these is at its maximum.

Then the yin becomes yang, right? And we start to see again, cross or intersect during the luteal phase. The yang begins to rise and the yin begins to fall. When we look at this and blow this up, blow up menstruation, we have During the menstrual phase, we have menstruation. The yang is going to peak and then drop in the qi and blood are going to be moving downward.

We know that, right? Because we have the discharge of menstrual blood or tian guai. The heart is going to be the one who is discharging During this phase, the invigoration of blood is going to be important to move all of the Tiangui out of the system. Next we have the follicular phase. During the follicular phase, the yin and blood in the system, are relatively empty.

Yin grows and crosses yang. And in this phase, the kidney tonification and blood nourishment is really important since we know that we’ve got this emptiness within the system, right? Building back, right? This is a constant Building and releasing. Building and releasing. We have, and there’s two builds and releases.

There’s the release of blood or Tian Gui, and there’s the release of the ovum, Yang and Yin, right? So the, these are really cool to play with this interplay with. So in ovulation, the Chong and the Ren and the Du are going to be fully activated. They’re going to be online. The Yin is going to be at its maximum.

The Qi and the blood are moving upward. In this phase, tifying the spleen to hold the blood is important when we’re thinking about fertility and also strengthening the Chung in the run. Now in the luteal phase, the yang is ra rising relatively rapidly and it’s warming the uterus needs to warm the uterus to prepare for that implantation.

Of the egg, of the follicle, right? The qi moves during this phase, so it’s important to both invigorate qi and blood. Now, what are the differences between western medicine viewpoints and Chinese medicine viewpoints when we’re talking specifically about fertility? In western medicine, we are looking at that endocrine function.

We are looking at the Hypothalamus, GNRH, and those feedback loops into the anterior pituitary and then those feedback loops to the reproductive organs. We’re looking at hormone balance. We are looking, hopefully, at organ function. And then we are looking predominantly at egg function. Quantity and sperm quantity and many of the interventions that western medical fertility doctors provide are to specifically increase quantity of egg and quantity of sperm.

This is a mechanical approach and it is a numbers game. If you’ve worked with clients for fertility, you are commonly seeing labs being run and they’ll look at the numbers being measured. A huge part of this. In Eastern medicine, we have a different viewpoint. We are looking at patterns. We’re looking at that yin and yang balance.

We’re looking at excess and deficiency. We’re looking at heat and cold. We’re looking at interior and exterior factors, right? We’re also looking at system function within the collaboration of the elements and the meridians. Then finally, we start to look at the systems in more specific ways. So we’re looking at the kidney water, the tian gui.

We’re looking at the liver blood. We’re looking through a cumulative and holistic lens. At the whole body and the patterns of the whole body, the entire symptom profile, the entire presentation of the client on the level of body, mind, spirit, and emotions is part of what we’re looking at when we’re trying to establish fertility.

We’re looking at the quality of the foods and the quality of the prenatal gene. So there are some significant differences here. Again, when the two are combined, is the collaboration going to be a unique solution to creating fertility in our modern world? And I think there’s a lot to be said for that. I think that collaboration is the key.

If, and here’s the if we don’t start talking to and educating our clients and our children as a collaborative, not just as acupuncturists, as a collaborative sooner about how they’re taking care of their bodies, what’s happening in their bodies, helping them to understand their own menstrual cycle and their own fertility.

If we are building health before the age of 14, before menstruation even arrives, before the maturation of sperm arrives, then isn’t fertility going to be easier in the first place? I don’t know, just a thought I have. Okay, so our unique perspective in Chinese medicine. The TCM approach to infertility treatment integrates the menstrual cycle as a simple, non invasive, sensitive, motivational, diagnostic tool to understanding a woman’s fertility status.

So that’s the nature that I talk about. It’s the nature of the body is what guides us to determine fertility, which is really about overall health in the system. Let’s chat here about the pelvic floor and fertility. While the pelvic floor And there’s a few studies that indicate this. While the pelvic floor is not likely a cause of infertility, there are seriously a few factors to consider.

One is that if there is pain in the pelvis and tension in the pelvis, One may be less willing to engage in sexual intercourse because of that pain and dysfunction. That pain or dysfunction may put them into strange body positions throughout the day, throughout, their life, but also throughout intercourse.

So again, that can really limit sexual intercourse. the ability for the body to conceive. If there’s pelvic floor dysfunction and dysfunction, I left it broad here because we could think about pelvic floor dysfunction as incontinence for example of bowel or bladder. If someone is experiencing incontinence, it’s going to be very difficult for them to be comfortable with engagement in intercourse, which can make it very difficult to conceive, right?

So there’s an indirect implication of how the pelvic floor can impact fertility here. But now we get a little bit deeper. If there’s congestion or there’s emptiness within the pelvic bowl, I think that can directly impact. Conception, right? There’s blood, which could be stagnation. It could be that the blood is not holding.

It could be that the blood has no motility. If the blood is, if the tiangui, or the blood itself, has stagnation, it’s not holding, or there’s no motility, I think it’s going to be very difficult for one to conceive. If there’s dampness or dryness, again, those fluids are not moving the way that they need to.

And if the fluids are not of high quality and they’re not moving the way that they need to then that can create potentially a block with pelvic floor which can impact fertility. There can be some physiological blocks as well such as accumulations like fibroids, endometriosis, we can have prolapses, there can be Altered spinal segment positioning, or SI joint positioning, and certainly these physiological blocks can also prevent one from being comfortable in the phase of connecting to themselves, connecting to what’s happening in their body, and being open to conception.

When we are in pain, and maybe this is a great research study, I hadn’t thought about that until now. When we are in pain. We are releasing different hormones, right? We are releasing a different set of hormones. So does the body have enough energy to then be at peak while it’s releasing peak reproductive hormone release while it’s working through the release of substance P?

I don’t know. That’s a good one. Injuries to the pelvic bowl are going to be another region. If there’s a trauma, if someone had a fracture, a ski accident, something like that car accident that impacted the pelvis in some way, or the sacrum in some way, that can definitely be a factor that’s going to at least contribute to fertility.

And then of course, energetic blocks. I think energetic blocks are definitely a contribution to fertility and many of those exist within the pelvic floor because the pelvic floor has many sinew connections. It has all of the meridians, most of the meridians running through it. The conception vessel and the governing vessel, which if the CVGV is blocked in general, I think it’s very hard to achieve conception through that state.

And I’ve really found that in my practice. And then finally, the spirit or the emotions. The pelvis is the root of the body. If the root of the body is holding emotions of trauma again, do we have enough energy to then conceive within the body? What does it take? So there’s a couple of studies out there that are sorting, starting to touch upon a connection directly between the pelvic floor, and fertility.

So in this study in BMC Women’s Health in 2024, this is like one of my favorite studies because it’s the first one that really starts to investigate this relationship. So this study for the first time investigates the causal relationship between reproductive factors and pelvic floor dysfunction.

The results suggested a causal relationship between some reproductive factors, but there were significant differences between female genital prolapse and stress urinary incontinence. So we’re starting to see that these physiological factors are impacting reproduction. In another study in alternative therapy health medicine in 2015, there were 13 192 female participants treated in a clinic between 2002 and 2011.

So this was almost a 10 year study, which is pretty amazing. And they had various diagnoses of infertility, including blockages of occluded fallopian tubes, hormone dysfunction, endometriosis. And some of the women were actually going to the hospital. through IVF. So the study was not specific. It was very general.

So we have to keep that in mind as we look at the results. In the intervention in this case, the clients underwent whole body patient centered treatments using protocols of manual PT which focused on restoring the Mobility and motility of the structures that affect the reproductive system. So specifically they worked on those concomitant tissues around the pelvis including, the back, the gluteals, the abdomen, etc.

The manual therapy represented an effective, conservative treatment for women diagnosed as infertile due to mechanical causes, independent of specific etiology. This is another big, important study. Basically, it’s saying that with a very minimally invasive approach, utilizing manual therapy, and no other interventions, utilizing manual therapy, we can impact what’s happening in the structure of the body, which can positively impact fertility.

So that’s an important correlation to consider. But is there some missing data? And I think there is. Unfortunately, there are really no data. Just few studies that link the pelvic floor to fertility, and until this one in 2024, there were almost none that were done on fertility as a whole. Some on interventions, specifically like PT or exercise or acupuncture, but none in direct connection between what is that correlation of pelvic floor dysfunction and fertility or infertility, right?

I think there are some questions. What types of pelvic floor dysfunction are correlated with infertility? What percentage of both males and females with pelvic floor dysfunction are also struggling with their fertility? Does a weak pelvic floor contribute to miscarriage? Likewise, does a tight pelvic floor contribute to miscarriage?

So is pelvic floor muscular dysfunction going to be contributing to one’s ability to hold conception? And are there specific gestational stages during miscarriage that are more likely to be associated with pelvic floor issues? I think these are important parts when we look at fertility and the pelvic floor as a whole.

So what can we do? Here are some pillars of pelvic patency, keeping the pelvic floor in an optimal state of nourishment and function. One is client education, and that is all encompassing. That can include helping the client to understand their body, to understand a little bit about what’s happening to their body.

During the phases of menstruation to help male clients understand what is happening physiologically during ejaculation, educating our clients on conception is really important. This is something that is missing in their childhood, but if they’re coming to see us in their fertile ages and they’re trying to conceive, this is the first line that we can start with is education.

We can also begin to educate them on patterns that we see within their body. If they are drinking smoothies and eating salads every day and they have a cold and damp uterus that’s a contributing factor, right? We understand those patterns. So helping the client to understand the patterns that are going on in their body and alter their nutrition or other factors, lifestyle factors, to help their body, give their body the optimal chance of success.

For healing, that’s a great way to start. Can also begin to educate our clients on posture as well. If we’re talking about mechanical issues within the pelvis that lead to pelvic floor dysfunction, educating clients on posture. And this could be as simple as if they have a desk job that every 20 minutes they stand up Do a little stretch and then sit back down right so that they can be in a place where their spine load is changed and they’re not stuck in a sitting position.

That anterior posterior tilt of the pelvis that they’re stuck sitting in is going to contribute to what’s happening within the pelvic bowl. Breathing. Breathing is so important. Encouraging our clients to get into the diaphragm with their breath, to take intentional breathing, to take intentional breaths is super duper important for the vagus nerve.

And the vagus nerve has fibers that go all the way down. to the pelvic floor. So it’s really important to work in breathing. And the pelvic breath is specific to recognizing that so often when our clients are experiencing leakage in particular, generally speaking, this is true as well. But if we think about leakage as our example, If they’re having leakage, very often it’s on the exhale.

So they are sneezing, coughing, or laughing, and then that produces leakage. Those are in exhale, right? So the pelvic floor is actually functioning in that state, in the reverse pattern of what we want. On the exhale, we want the abdomen, we know this if we’re yogis or therapists in general, we want the abdomen to be coming in.

We also want the pelvic floor to be coming in and out on the exhale. That’s the excretion of air. That’s sending the air into the world, right? That’s the excretion. On the inhale, we want to fill and we want to relax the abdomen. We want to relax the pelvic floor. So encouraging our clients to understand the pelvic breath is very important.

Finally, movement. Movement of qi and blood is particularly important to the health of the pelvis, right? Staying out of phases of stagnation is key and also encouraging our clients to move according to their cycles is really important. At the beginning of one cycle during, the menstrual bleeding phase, the tian gui release phase, it’s important to consider that clients might be a little bit more tired.

They’re not going to be at their peak of exercise during ovulation. They might feel great. They might feel like they can handle more exercise, more weight in the gym, a longer endurance activity, whatever it might be. And that’s okay. And it’s important for them to understand that their body feels different throughout these phases.

And that’s okay. as long as they find some way to move their body. Acupuncture. We are master technicians at working through patterns and helping to resolve the pain. imbalances. So acupuncture can really support our clients in treating those sinews, in opening blocks, and in nourishing the reproductive system in the exact way that it needs based on that presentation.

And of course, dissolving Accumulations is key too. And finally, if you’re into manual therapy, which I am, I love manual therapy. It’s a big part of my practice. Utilizing that manual therapy to help restore balance and establish embodiment. And this, if you’re not trained in pelvic floor work, it doesn’t have to be specific to the pelvic floor.

It can be within those concomitant structures. Don’t downplay working on the abdomen, working on the back, working on the butt, working on the anterior hips. in order to support our clients going through fertility.

Okay, so here’s a little bit about my series with the AAC, the American Acupuncture Council. If you’ve seen me before, you’ve probably seen my pelvic floor intro, as well as my pelvic floor and menstruation workshop coming up soon. We have a workshop on pregnancy. on postpartum and on menopause all in relation to the pelvic floor.

Again, I want to thank you for being with me today and I want to thank the AAC, the American Acupuncture Council, for hosting me through this series and sharing these blogs so that acupuncturists around the globe can get into the sacred medicine of the pelvis. Thank you so much for being with me and I really look forward To seeing you soon, take care.

 

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