Amanda: (00:00)
Hey everybody, welcome to another edition of slumber party. I invite you to my slumber party, except unlike the ones you attended in the 90s. This one actually includes sleep for you, your children, and the entire family. Every week I have any unique guests or I answer a fun question about sleep to get you in your family, this sleep that you need. Today we’re talking with Chana Ross who is a, I wanted to say vagina physio, but that’s not what she is. She’s a pelvic floor physiotherapist out of Vital Physio in wellness in Midtown Toronto. She is such a force of nature. If you’ve ever met Chana in real life, you’re just enveloped by her energy and her fun and her laughter. She’s so, so, so great. And we’ve been wanting to talk about sleep and vaginas for a while. I, we always do a deep dive, but this was a pretty good deep dive into some mental health stuff as well. Some things that you might want to look out for, for yourself. Chana can be found online. She gives all of her links. Take a look at Vital Physio Therapy and Wellness online. If you want to get in touch with her or book an appointment with her or her team. Thanks for joining us. This is a judgment free zone. All types of sleep are encouraged. So put on your headphones, walk around for the duration of a crap nap, and just enjoy yourself.

Amanda: (01:38)
Hi Chana. Are you there?

Chana: (01:39)
I am here. How are you?

Amanda: (01:42)
I’m great. How are you?

Chana: (01:44)
Good, thanks. Thanks for having me.

Amanda: (01:46)
Thank you for, so I’m so embarrassed when I record virtually with people who are literally down the street.

Chana: (01:59)
We so should’ve done this side by side! That would’ve been fun!

Amanda: (02:01)
It would have been, but you are a busy woman, you’re at work right now, right?

Chana: (02:06)
Yes! I am hiding in a back office in my clinic.

Amanda: (02:11)
Honestly, the sound there is really good. So if you ever decide to do a podcast, you should do it in that room.

Chana: (02:16)
When?! Alright, Done!

Amanda: (02:17)
Just stop sleeping, right, and that’s all you need to do.

Chana: (02:23)
That’s great. We’ll just add that to the list. Okay.

Amanda: (02:27)
Yeah, that’s it. Don’t worry about it. Okay. So Chana, you are, the vagina queen.

Chana: (02:36)
Is that what I am?

Amanda: (02:36)
Yeah. Yeah. I actually think you’re so smart because a lot of physios offer a pelvic physio, but Vital actually specializes in it. So why don’t you tell us a little about you and what you, where your clinic is and what, what you do there.

Chana: (02:53)
Sure. Talk about myself? Okay! My name is Chana, I’m the clinic director at Vital Physiotherapy and Wellness, which is a perinatal clinic ,pelvic health clinic in Midtown Toronto. And we have a multidisciplinary clinic. We have seven pelvic health physios, so physios who really focus in on pelvic health, and prenatal prep and postpartum recovery and different areas, like, you know, different times in a woman’s life in and around menopause. We treat after mastectomy and breast cancer and a whole host of things that women experience. But we also have a, but wait, there’s more. Amanda! I have an amazing chiropractor and naturopath and massage therapists and we run, exercise classes all focused on women in the perinatal period and in and around menopause.

Amanda: (03:58)
Awesome. That’s so great.

Chana: (04:01)
Whew that was a lot about me!

Amanda: (04:01)
You’re also sort of a community hub. So I live in, you’re in Midtown, on St Claire West in Toronto, and I live around that area and there’s always something going on there. You know, you’re always hosting classes, mom and baby things, fitness stuff. Like you’re just really good at that. You are a community builder for sure.

Chana: (04:24)
Thank you!

Amanda: (04:24)

Chana: (04:24)
I, you know, I, I as you know, I think that, you know, sometimes motherhood or Parenthood can be very isolating. And so one of the ways that we feel better is, is just by being around nice people. So that’s something I try to do! Very technical.

Amanda: (04:46)
Bring good Juju into the, into the place!

Chana: (04:47)

Amanda: (04:47)
So I think that like one of the things, so we talk a lot just casually on our own and we’re always trying to collaborate on something. And I wanted to have you on as part of my, after the sleep series of some experts and guests who can help parents and moms figure out next steps once their head is on straight, right? Like, once you’re sleeping your eight hours again and you’re sort of being like, “okay, now I have some time to do some things. My body is ready for a little bit of a change.” You know what, how can I do that? So like I said, I’m talking to Dara Bergeron who’s a fitness expert. I talked to Your Shop Girl about some, some clothing stuff and we’ve always sort of talked about how for pelvic physio, sleep is required. And so I definitely want to talk about this, but I also, for those who don’t know what the hell would be wrong with their vagina or why they need to go see a pelvic physio, I would love for you to talk about this because truth be told, I didn’t know that this was a thing. And pretty much until I knew you and I was, “Oh” like I’ve randomly heard about some people I know who had like trauma, seeing someone, but there’s a whole clinic devoted to it? And then like now I’m in, like now I’m all in, I know what’s going on. But tell, tell the average person who was like me, what you do!

Chana: (06:21)
Okay! I would love to. So I guess, one of the things that we think about, we think about pelvic floor, and I will, I will launch into anatomy cause it’s one of my favourite things to talk about, but when we talk about our vaginas, what we don’t realise is like our vaginas are actually made of muscles. So the pelvic floor is three layers of muscles that sit at the base of your pelvis. So if you literally take your hand and you put it on your crotch, you’re welcome. You’re, you’re placing your hand over three layers of muscles that are called the pelvic floor muscles and they, they extend from the front of your pelvis at your pubic bone, which is right above like, you know, your Mons pubis, where your hair is. Right behind that is your pubic bone. It goes all the way to the back at your tailbone, which is literally at the top of your bum crack, and side to side from one sit bone to another. So it’s like a bowl of muscle that sits at the base of your trunk and has five really important jobs. Job number one is to hold up your organs, hold up your bladder, your uterus, your rectum, and all of your internal organs.

Amanda: (07:42)
Is that the muscle that kind of goes when you have like a prolapse.

Chana: (07:46)
So yeah, so a prolapse is when that role is not being done correctly. So, your organs, your bladder, your uterus, and your intestines and your rectum, they’re held from above with ligaments, and ligaments have like a little bit of elasticity to them. And over time, the same way like a hair elastic, when you keep wrapping it over and over and over again, it starts to get stretched out. Over time, those can get stretched out. So you’ve got that support from above, like inside, and above those organs. But below the organs are these three layers of muscles and they help hold them up as well. But, these muscles are like any other, the only thing they’ve ever heard is to kegel. Right? So, you know, use it or lose it. Same thing like any other muscle if you’re not using them correctly, then it’s up to the ligaments to just keep holding on. And so either a really very fast forceful activity, like delivering a baby. Yeah. Or things like persistent, like persistent, like, very small… Somebody who has a chronic coughs or somebody who weightlifts all the time and holds their breath and bears down all the time. Someone with chronic constipation, you’re getting that constant downward pressure, that’s putting pressure on the ligaments. And if the muscles below are not trained to manage that pressure, then then we start to see some of those organs descend, and they can descend out of your vagina or out of your rectum.

Amanda: (09:33)
Wow. Okay. Shit.

Chana: (09:34)
Does that make sense?

Amanda: (09:36)
Yeah, it does make sense. It’s crazy.

Chana: (09:42)
So your vagina’s on the only orifice in the pelvic floor. So you have your urethra, where your pee comes out of and your bladder is right on top of that, your vagina, you have your cervix and your uterus right on top of that, and your, your anus and on top of your anus is your rectum. And what’s really interesting is all of those, your urethra, your vagina and your anus, they’re muscular. The muscles are, they basically go progressively, almost like a sandwich. There’s an outer layer, a middle layer, and a deep layer, and there’s three layers of muscles so you can retrain these things, right? So prolapse sounds really, really scary. And to a certain degree we can really rehabilitate prolapse. There are other options when rehabilitation isn’t fully going to help, but, a lot of the things that, so we’re going to talk about. So number one, is it’s supportive, right? These muscles support all those organs. But a lot of the things that we think of postpartum in relation to our nether regions, we think of them as like, “Oh, well what did you expect? You had a baby, obviously you’re going to have prolapse.”

Amanda: (10:46)
So much of what I hear is “You’re never gonna sleep again. You had a baby, that was your choice.”

Chana: (10:54)
YES. Exactly! That’s why I love you, right? Like these things that we just like… And they’re beliefs, they’re beliefs that we’re like, well, “what? Of course that’s going to happen.” Well, no, not of course. Like there’s so much that, I think that we feel so defeated postpartum because, you know, we’re like, well, my life will never be the same. It won’t ever be the same, but it’s likely going to be better. Right? But we have to put the pieces into place to make that, to make that the case. Right?

Amanda: (11:21)

Chana: (11:22)
I get very off track. So the first.. it has Five jobs, like, reign it in Chana!!

Amanda: (11:31)
No you’re doing great! I mean, I’m following along, I’m interested in what’s happening. I’m not everyone listening, but I’m in!

Chana: (11:37)
I love it! Okay so the first job is to hold up your organs. The second job is to keep you continent, so to make sure you’re not leaking urine when you don’t, you’re not sitting on the toilet and to make sure that you’re not leaking feces or gas when you’re not sitting on the toilet and to help you release and make sure that you actually can fully evacuate your bladder when you’re sitting on the toilet and have no issues with, with bowel movements. So constipation is very much related to pelvic floor muscles that aren’t working well and as is leaking urine. And even if you’re leaking urine, when you’re jumping on a trampoline with a full bladder and you cough and your kid pushes you, you still shouldn’t, you shouldn’t lose urine unless you’re sitting on a toilet.

Amanda: (12:20)
Let’s pause there for a second because this is something that you’ve taught me and it was an “aha” moment for me. But like the hours and hours of Depends commercials I’ve watched lead me to believe that leaking urine after a certain age or especially, you know, you see online, “Oh, I just had a baby and I sneezed. I also went to the bathroom.” Like, it just feels very normal.

Chana: (12:44)
What do they call it? Like a Speeze? I don’t know. There’s different names.

Amanda: (12:50)
But that’s not normal. You’re saying that’s not normal and it can be helped.

Chana: (12:55)
No. No. Like it’s totally treatable, like not like, “Oh, we can help a little bit.” It is treatable. And, and the thing is about the pelvic floor muscles, when things are not working well here, like when you’re peeing your pants, when you’re having pain in your vagina, when you feel like organs are falling out of you, that genuinely affects your sense of self. And yes, I’m not gonna lie, we joke a lot. Like we, it’s, we try to make it lighthearted while we’re chatting, while we’re chatting about it. But when things are not working well, it really alters a person’s sense of self in a drastic way. Women don’t want to leave the house. They don’t want to, you know, they don’t want to be intimate with their partners. They don’t want to, you don’t wanna go out for extended periods of time just in case they leak, right? They don’t want to go out at night. Like, it affects their lives in a very drastic way, as does lack of sleep. And so, you know, it’s really important to get it taken care of.

Amanda: (13:56)
You know I have a, I have a friend, who will remain nameless but who has a prolapse issue. And I was not really aware of the emotional connection there, you know, we were talking about something completely unrelated and she said something like, “Oh, uh, I’m, you know, on this, message board for women with prolapse. And we were talking about stress and like, ‘Oh, they take this for their anxiety’.” And I was like, about prolapse, and I was like, wow, like this is like, it can cause depression, anxiety, when you just don’t feel like you’re fixed or that you’re working at 100%.

Chana: (14:38)
Totally. And you spiral very quickly into, you know, what did I do that caused this? Like, what is, what, well, how did I create this situation? I shouldn’t have done this. I should never have done this. Like we go quickly into self blame, very quickly. I mean, another thing about the pelvic floor is the pelvic floor gets, direct innervation from the autonomic nervous system, from our sympathetic system, our fight or flight. So when we’re stressed, our pelvic floor responds automatically by overworking. And so when we are not sleeping, when we’re, you know, in those early stages or early to late stages of Parenthood, when, you know, we are in that constant spiral of I’m not doing well, I don’t know what I’m doing, dah, dah, dah, dah, dah. When, when we’re not eating well because we’re feeding a baby all the time and like can barely have time to brush our teeth when we don’t have good social support cause we’re at home all the time by ourselves. And that, those, you know, in, you know, when we live in a big, we live in a big city and there are a lot of people all by themselves. When you’re in that stressed response, we, our pelvic floors go into this fight or flight, which is just a clenched position. And so we, which is why I say I won’t, like when somebody is not sleeping, I’m like, you need to deal with the sleep first. I need to take care of you because keep coming back. And if it’s like, and if you’re still not sleeping and you’re still not eating, you’re still like, we’re just going to have to, I’m just going to give you the same advice over and over and over again. And really like it’s not fair to keep blaming yourself. Like, “well, I can’t, it’s because I’m not doing my homework.” Well it’s because I’m like, no, like you need to take care of the base and then we can take care of this other stuff. Because if you’re in that constant fight or flight, we’re not, we’re not going to get you. We’re not going to get these muscles to do what they need to do. We’re not going to get them to relax because in order to do that, we need to get you into a, into a rest and relax state.

Amanda: (16:46)
And I feel like, yes. Okay. So, you know, personally, this is such a, this is a personal issue for me and I actually wrote about it on my blog and my newsletter this, this month. We’re actually talking the day after I send it out, but I basically talked about my two years after my second baby just being in a constant state of fight or flight, but also not really knowing it and not really believing that. Like people would be like..

Chana: (17:17)
It’s so easy to think that’s normal.

Amanda: (17:17)
or, or to be like, no, like I know I’m busy, but that’s really not affecting my body. Like, give me a break. Like that’s just something that you hear to calm down. No. It’s, I can tell you with 100% certainty that, my stress affected my body. Like I, I remember my hair was falling now and just falling out and falling out, I had a bald spot. I was like freaking out. So, I went to the doctor, I went to a specialist, I went to a dermatologist and all of them, like I had a million blood tests. I had this and that and, and it was like nothing was wrong with me except clearly everything was wrong. And I remember the dermatologist being like, look, I see people like you every day. I can almost guarantee that you have too much stress in your life. And at the time I was like, I’m not doing anything different than I normally do. But it was a moment where it was like, maybe I can’t do what I always did before. Maybe I need to stop doing that now. And like being on the other side of it is actually like that is why I wrote the blog because there’s so much knowledge on the other side of being like, “Oh man, my, well I can literally feel a difference in my body”. Like my body isn’t like a 20 outta 10 anymore. Like my shoulders are down. Um, you know, all of those things like even I would go pee all the time when I was nervous. Right?

Chana: (19:02)
Urgency, or that feeling of “I can’t hold it anymore.” That’s just, that’s a sign that your bottom, your pelvic floor is overworking. And when we’re telling, when we’re talking to clients and saying, you know, there’s this.. Like telling somebody to relax, he’s not relaxed like, that’s a joke, right? Big difference between saying this is brain remediated versus it’s all in your head and, and our brains are malleable. We can change it, right? There’s neuroplasticity, we can do so much, in that way. But sleep is a big part of that. Right? And if we give a lot of suggestions around calming the nervous system and retraining that stuff, but at the end of the day, if your baby’s getting up every hour to nurse, that might not be, a you not being able to sleep issue, that’s your baby keeping you up issue. And that has to be addressed. If someone chooses to of course.

Amanda: (20:02)
Of course, and I think that, you know, always, I have this disclaimer, if your baby is waking up every hour to nurse, especially if they’re newborn, that’s, that can be normal. And if you’re doing that and you’re okay, meaning like there’s nothing going on, then there’s nothing going on. Like we’re not, you know, prescribing anything. There’s no ideal scenario. It’s only if you’re not coping and there are people, and I would put myself in this camp, I’m kind of a little bit of an asshole because like my kid would sleep for… I was a person who postpartum would be like, “Oh, you know, Nora only slept in four hours stretches last night.” And then this other woman would be like, I hate you. Like I, I would love four hours. But for me, my four hours was like, I could not function. So it’s like everyone has their number about whatever that is. But yeah, it seems so.. It’s so interesting because I feel like you just hit upon something that I really want to talk about that we might need to change the language about how we talk about how the body and mind are connected. Because I would consider myself pretty, you know, quote unquote “woke” to mental health and how it affects the body. And I was still in denial about how it was affecting me. And I..

Chana: (21:29)
Oh, well listen, like we’re really great at helping other people, it’s just not ourselves.

Amanda: (21:34)
100%. Just don’t ask me to do anything for myself. I mean that’s not true. I’m so much better at that now. I’m actually like, I’m, I’m very, very happy about where I’ve come. But I think that, you know, you’ve hit the nail on the head that we need to say, we need to break it down exactly how you did it. Like your autonomic nervous system is directly related to this issue. Here is how, this is how… And like once it was broken down to me that way, I was like, “Oh” cause like when your hair is falling out, you’re like, why? And it’s like well your body thinks that there is a significant stress. It’s putting all of it’s energy and other areas and doesn’t give a shit about whether or not your hair grows. And I was like, “Oh, I want to give a shit.”

Chana: (22:24)
Right. Your body, your brain doesn’t know the difference. Like your brain doesn’t understand if there’s a tiger or if it’s your baby waking you 100% of the morning. Right? You respond in the same way. And like the other piece that this affects is, your intimate life. So pain with sex, pain with sex is very common. First of all, after somebody had a vaginal delivery and there’s a, and there’s any scarring but also cesarian delivery, we see a lot of pain with sex because again, your muscles go into that over active state, it’s going to hurt with any penetration or stimulation.

Amanda: (23:14)
Yes. And I mean that, I see that as well. Like if you’re, you’re also not sleeping or if you’re bed sharing and you don’t want to be, you know, intimacy can be really challenging. Which I’m sure is also compounding on that mental health part. Right. You, your body’s not working, you’re not having sex with your partner. Um, you are, you know, peeing yourself like that’s, that’s some complex stuff.

Chana: (23:38)
You hate your body. You hate. Yeah. Like there’s, people are really beautifully complex. Right? And so I think that, you know, we see, we actually see a lot of our clients postpartum, they come and work on, they would come in cause they want to work on their core postpartum and rehab it. And your inner core is actually made up of your pelvic floor, your inner ads, your inner back muscles and your diaphragm. And all those four muscles like your inner abs and your breathing muscles and your pelvic floor are all significantly affected by pregnancy. And then postpartum have to learn how to work together again, but your diaphragm is like your deep breathing muscle, right? If someone could take a diaphragmatic breath in. That’s like a full nice deep breath. And again, if you’re in this state where we’re not sleeping and you’re not functioning well, it’s really hard to take in a deep breath. but it’s one of the only ways that we can affect change. We can bring on that parasympathetic state that rest and relax, is by starting to take slow and deep diaphragmatic breaths. And then guess what? It not only helps you change the state that you’re in, it also starts to affect change in helping your pelvic floor relax. Because we think about contracting or pelvic floor, not about relaxing it, but that’s one of the first things we teach women to do is, or our clients I should say, is learn how to take a slow diaphragmatic breath because those two muscles work in synchrony and they help your inner ab muscles start to function as well. So I think just being able to find that balance between this overactive state and it doesn’t feel like you’re overactive cause you’re tired all the time, right? But your nervous system is, is really ramped up and again, it’s not all in your head. It’s really like we can really change where our brain is at with a lot of this stuff by starting to do some of this slower, gentler breathing. Maybe throw in some meditation or gentle movement, but like seriously not going back, like bootcamp. Returning to bootcamp afterwards is just actually, it raises your cortisol levels. And so getting women to be kind and slow postpartum is really the most important thing I can share.

Amanda: (26:11)
So there’s two things I want to say. One belly bootcamp is different because Dara and her team actually like understand the core and the pelvic floor and they’re going to be like, “get down on the floor!” Like it’s, I’ve, I did belly bootcamp for like three years and they are awesome.

Chana: (26:32)
Yes, find your people!

Amanda: (26:32)
The other thing that I want to explain if the incase this isn’t clear, but I had it explained to me really well a few years ago, but why a lack of sleep does stress out the body. And it was like back in, you know, prehistoric times or whenever we were just people living in caves. If we weren’t sleeping, it meant that there was a threat nearby. And so if there is a threat nearby, your body turns on every single super awake hormone because you need to be alert and aware for everything. You need to be tracking all the time. So it means that you’re in a state of hyper vigilance, waiting for that threat to happen. And so you don’t necessarily, like I said, like I didn’t know I was in a hardcore state of hyper vigilant.

Chana: (27:24)
You can adapt hypervigilance, right? You adapt to that state and that becomes your new norm. So you actually dont know that’s what you’re experiencing.

Amanda: (27:28)
I would argue like if you’re very anxious, if you’re worried about things in a way that you haven’t been worried before, if you were getting sick all the time, if your immunity is low, if you are feeling depressed, like very, very, very tired. That’s your body responding to stress and a lack of sleep. And probably, you know, it’s, it’s time to seek help either in sleep or, or talking to your, your doctor. And getting a referral to a mental health worker. It doesn’t have to be like a psychiatrist. It doesn’t have to include drugs. I think, It can include drugs, which are totally fine and safe and good, you should always talk to your doctor about that. But people are often afraid to go and make that first step. And, and most doctors these days are really kind of switched on to, you know, postpartum or it doesn’t even have to be postpartum. It can just be a motherhood because it is stressful. Right.

Chana: (28:33)
Yeah. I really, I think that we’re not talking enough about the fact that, new parenthood or motherhood in general, it’s like an existential crisis, right? When people think about themselves while they’re pregnant, and I think of themselves postpartum, they picture themselves, they just have a child’s beside them. But it’s actually you’re creating a new identity. And with that comes also a new body and a new relationship with your spouse and a new relationship with your child and your relationship now with like your parents and you’re trying to process all this while you no longer have, you know, authority over time, you know, no longer are sleeping the same amount your food is, there’s, there’s so much happening. And so it’s important to find your people and make sure that, that you, you’re taking care of yourself as best as you can, or you have people around you to take care of you.

Amanda: (29:37)
Well, that is honestly, I think the best place to stop our crap nap conversation because, I mean where do you go from there, Chana? How if you’re, if you’re my people, where do I find you on the internet?

Chana: (29:52)
You can find us on Facebook at Vital Physiotherapy and Wellness on Instagram, @vitalphysiotherapyandwellness, and online:

Amanda: (30:03)
Awesome. Thank you so much, Chana. We will find you. You are, my people.

Chana: (30:08)
Thank you. You are my people, Lady! Thank you for having me, Amanda!