The Crackin' Backs Podcast

Bladder Leaks Aren’t Normal: The Pelvic Floor Truths No One’s Telling You – with Susan Winograd

• Dr. Terry Weyman and Dr. Spencer Baron

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Is bladder leakage normal? Are Kegels really the gold standard? And what exactly is your pelvic floor doing for you every day—whether you’re pregnant, postnatal, or neither?

In this eye-opening episode of the Crackin’ Backs Podcast, we sit down with Susan Winograd, MSPT, a pioneering pelvic floor physical therapist who turned one painful moment during her own pregnancy into a mission that’s helped thousands reclaim their health, strength, and dignity.

With over 25 years of clinical experience, Susan breaks down what the pelvic floor actually does, why it’s essential to understand its five key functions, and why ignoring common symptoms like leakage, low back pain, or core weakness could be your body’s version of a flashing “check engine” light.

But it doesn’t stop there. Susan challenges outdated advice and explains why Kegels aren’t a one-size-fits-all fix—revealing powerful, science-backed alternatives and techniques that most people (and even doctors!) don’t know about. You’ll also learn about her revolutionary Five Pillars of Pelvic Floor Health and which pillar is most commonly neglected.

We also tackle the myth that pelvic floor issues are “just a women’s thing,” and explore how better training for providers can close the gap in care that leaves so many suffering in silence.


About Susan Winograd, MSPT
Susan is the founder of Embodied Physical Therapy & Yoga in New York City, where she specializes in pelvic floor rehabilitation, prenatal and postpartum care, and integrative physical therapy. Her compassionate, holistic, and movement-based approach bridges science and healing. She is also a yoga therapist and educator, combining traditional PT with breathwork, mindfulness, and body awareness.


Expect to learn:

  • What your pelvic floor really does (and why you can’t ignore it)
  • The truth about Kegels: are they outdated or misunderstood?
  • Common symptoms that signal pelvic floor dysfunction
  • The 5 Pillars of Pelvic Health—and which one you’re probably neglecting
  • Why pelvic floor care isn’t just for women or new moms
  • How healthcare providers can better screen and support patients


Connect with Susan Winograd and Learn More:
Website: https://www.embodiedphysicaltherapy.com
Susan’s Podcast: Your Pelvic Health Podcast – Listen on Spotify
Instagram: @embodiedptandyoga


Don’t forget to subscribe, rate, and leave a review if you enjoyed the episode!

We are two sports chiropractors, seeking knowledge from some of the best resources in the world of health. From our perspective, health is more than just “Crackin Backs” but a deep dive into physical, mental, and nutritional well-being philosophies.

Join us as we talk to some of the greatest minds and discover some of the most incredible gems you can use to maintain a higher level of health. Crackin Backs Podcast

Dr. Spencer Baron:

Is bladder leakage normal? Are Kegels exercises really the gold standard, and what exactly is your pelvic floor doing for you every day, whether you're pregnant, postnatal or neither. In this eye opening episode of The cracking backs podcast, we sit down with Susan Winograd, a physical therapist, a pioneering pelvic floor physical therapist who turned one painful moment during her own pregnancy into a mission that has helped 1000s reclaim their health, strength and dignity. With over 25 years of clinical experience, Susan breaks down what the pelvic floor actually does, why it's essential to understand its five key functions and why ignoring these common symptoms like leakage, low back pain or core weakness could be your body's version of flashing the check engine light. But it doesn't really stop there. Susan challenges outdated advice and explains why Kegels exercises aren't a one size fits all, revealing powerful science backed alternatives techniques that most people and even doctors don't know about, you'll also learn about her revolutionary five pillars of pelvic floor health, and which pillar is most commonly neglected. We also tackle the myth that pelvic floor issues are just a women's thing, quite frankly, and explore how better training providers can close the gap and be more careful about who's really suffering in silence. Men included. Enjoy the show. Well, good day. Susan Winograd, it is great to have you on. We're going to cover a very interesting subject today. Welcome to the show. Thank you for having me. Oh, very much. So we've heard some fun things that you have, that we have in store for you, that we're going to talk about pelvic floor today. Pelvic what? Yes, pelvic floor. Now, this is an obscure body part, because most people don't talk about this type of thing, but I know you have braved the conversation and have some really cool ideas for people that have different symptoms that I mean, I remember, no kidding, 30 years ago, a woman came in to my office that was a runner, and she would just say, by the second or third mile leak all over the all over her pick can't get to a bathroom fast enough, so welcome to the show. Can't wait for you to address stuff like that. I'm

Susan Winograd:

so excited to be here, and I know most people don't talk about it, but I talk about it all day.

Dr. Spencer Baron:

Well, well, let's just hope that they don't do like you. They do to Dr Terry and I in a grocery store say, hey, you know what I got? Can you check my I go, we're in the middle of the produce section.

Susan Winograd:

I have a better one for you. I was at a wedding a couple weeks ago. Woman ran over to me and said, I just peed myself.

Dr. Spencer Baron:

No, no, oh, my

Susan Winograd:

God. Like, okay, see you on Monday in my office.

Dr. Spencer Baron:

Oh my gosh. What a great way to start the show

Susan Winograd:

that happens to me pretty often.

Dr. Terry Weyman:

Wow. Well, and I thought going, Oh, I have a headache. Can you help me with a headache? Was bad. Yeah,

Dr. Spencer Baron:

that's become boring, and I'm sure there are more symptoms,

Susan Winograd:

really exciting. Shoulders,

Dr. Spencer Baron:

very good. All right. Well, I just want Dr Terry to know that Susan is located

Dr. Terry Weyman:

in Florida. Thank you very now, sorry. I just want you to you know, there's this east and west coast, west coast rivalry that we have all the time. What that mother's saying is only people in Florida pee in their pants at weddings. So I'm okay with that.

Susan Winograd:

People in Florida talk about it.

Dr. Spencer Baron:

That's right. Good job. So, so, Susan, let's get down to the, well, we already started getting down to the, you know, you talk, you turn that moment of pain in pregnancy into your mission. Like, how did that all start for you? Like, did was it a personal thing? I mean, go, go with it.

Susan Winograd:

Well, I had really, really difficult pregnancies, and during one of my pregnancies, it was my third one, I'll never forget. You know, sometimes in your life you don't forget a moment. You remember the smell, you remember the lighting. I was in my third trimester. Semester with my third child, I had not felt well the whole time, and I told my husband, I'm like, You know what? I need to, like, air my brain out. I'm gonna go to the mall and just kind of, like, walk around, like, aimlessly. So I went to the mall. I'll never forget I was on the second floor in front of a Banana Republic, and I got a sharp shooting pain, and I could not walk. And I remember thinking I called my husband. I'm like, I can't move, so much pain. And I remember my only concern was, like, how am I going to get back to the car? So my husband, like, you know, kind of calmed me down. He's a physician. He calmed me down. I got back to the car, I went home, and what do you think the first thing I did was, I called the doctor. I called my OB, and she said, You know what? Come on in. And I went to the OB, and I said, you know, I I'm not feeling well. I'm in a lot of pain. This hat thing happened to me in the mall, and she looked at me, she said, Oh, honey, pain during pregnancy is normal. We'll take care of it after you have the baby. And mind you, I worked in a hospital at that point. I'm sorry. That was my third one. I worked in an orthopedic outpatient clinic at that point, I'm a physical therapist. I don't have a desk job, and I had planned to work till the end of my pregnancy. So I looked at her, I'm like, there, there's got, there's got to be something. I'm like, This is not normal. And she's like, Honey, don't worry about it. You'll be fine. And it was like at that moment where I was like, this, this is not okay. And I think that the interesting thing about my career, I've been a physical therapist for 30 years, but at every point in my life, I something similar to that happened, which led me to expand the next phase in my career. So, for example, I'm 52 years old. I am in perimenopause. I don't know how graphic you can

Dr. Terry Weyman:

get. You can get graphic.

Dr. Spencer Baron:

You get real graphic, dammit. So,

Susan Winograd:

so I said, you know, I was perimenopausal. I was not feeling well. I felt like I had brain fog. I was tired. I was getting a lot of anxiety. So I went to the doctor, and she really did not know my my GYN really didn't know much about hormones or hormone therapy. And she said, You know what it sounds like. We want low libido, low drive, low energy. Here's some testosterone cream. Put it on your perineum and you'll be fine. I'm like, You want me to put it? Where isn't that going to make like, everything down there grow in proportions? That's not normal. And she was like, and then she looked at me and said, Are you really going to complain about that? Now, really this? You can't make this up like I hear these stories all day long. But this happened to me. I have clients who have said their doctors told them to see a psychiatrist. So at that point in my very menopausal life, I became obsessed with all things hormone balance, and I learned a ton, and I learned that maybe that's not the place, best place for testosterone. There are other ways to do it. And you know, women need testosterone as much as men. They really do, but we women have to be educate, and then we see men too. People need to be educated. You know what you don't you know. You know what you don't know, but you don't know what you don't know. And now my mission is to spread awareness on you don't know what you don't know. I want people to know that all of this so they could know just because it's common doesn't mean it's normal. It's not normal. And if you feel something, say something. And if you feel something, chances are that you can do something about it. And that's really, really been my mission, and my passion throughout my career, is helping people to be educated so they can have effective communication with their health care providers. I

Dr. Spencer Baron:

think it's fascinating the evolution of health care and how dramatic it's been. You know, it wasn't too long ago that Dr Terry and I would hear from, you know, our patients, oh yeah, the doctor told me that I'm, I don't need vitamins. I'm on a good diet. Well, what, you know, good diet in America is not that good anymore. So the evolution has changed. I love that we're talking about a subject that's been so remote. You. And that could give answers to people. So you talk about, you know, well, let, let's actually tell some of the listening audience that is not aware, what is the pelvic floor? What is it? And give us a little feedback on what the, you know, the functions of it are. How much time do we have? We got all sorts of time for

Susan Winograd:

hours. So, this is basic anatomy, which applies to men and women, basic anatomy that everybody should know. I'm gonna just grab my pelvis here for a minute.

Dr. Terry Weyman:

I'm grabbing my pelvis right now. The

Susan Winograd:

pelvic floor muscles are a group of muscles that lay at the base of the pelvis so Dr Terry, or I, you know, Dr Barron, if I were looking at you from the head down, the pelvic floor muscles would look like a bowl shaped a dome shaped a hammock, shaped group of muscles, and they go from the pubic bone all the way back to the tailbone and from one side of the hip to the other. Now it doesn't it is so fascinating because it's so much more complex than people think. There are three layers of pelvic floor muscles. Each layer has three muscles in it, and then we're talking about left and right. So it's pretty complex. It is its functions. We call them the 5s is spenteric, because there's a closure mechanism. So we're now peeing and poop and roll over the floor, right? There's a sexual component for sexual appreciation, the first layer of pelvic floor muscles is the external genitalia. So I can ascertain a lot by what's going on. Not not only the the like the penis and the testicles are not part of the pelvic floor, but there are a lot of attachments. There's a muscle in males called the bulbo spongiosis that's responsible for helping ejaculation. There are a lot of muscles in the women that attach the clitoris and the perineal body, um so sphincteric, sexual supportive, because the pelvic organs sit right on top of the pelvic floor muscles stability. The pelvic floor muscles are part of our deep core system, which is a separate podcast that we can talk about. And then there's some there's a lymphatic component because the pelvic floor muscles, it's skeletal muscle. So as those muscles contract and relax, it helps to help lymphatic fluid move throughout our system. So it's a pretty, pretty damn important muscle group that we it's like one of those muscle groups that do everything, but is very under recognized for everything.

Dr. Spencer Baron:

Issues, what? What can go wrong. What would what are the variety of symptoms that somebody can come to you with?

Susan Winograd:

Yeah, dysfunction. I call that. So that was the five S's. Now we're going to talk about the four P's, okay, pee, pooping, pain and pressure. Got it so, urination leaking, if you're leaking, if you're if you feel like you can't fully evacuate, if you have urgency, if you have frequency, if you have hesitancy. For women, if you're getting a lot of lower urinary tract symptoms, anything bladder related, any involuntary loss of urine, having to go to the bathroom but not being able to get there in time. That's that's your body telling you you should pay attention to the pelvic floor. Let's go on to the second P pooping, constipation, incomplete evacuation. Incomplete evacuation is probably one of the more common things I see where people say, I feel like I'm pooping all day. I can't I start a little pebble comes out, I can't get it out, and I just seem to be busy with the bathroom all day. So constipation, incomplete evacuation, fecal urgency, inability to hold back wind. If you're in a crowded elevator and you gotta pass gas and you can't hold it in, that's a problem. That's your pelvic floor saying, either get out of the elevator or visit the pelvic floor therapist,

Dr. Terry Weyman:

or that should becomes a problem for the people in the elevator. Correct,

Susan Winograd:

correct. So anything bowel related sexual pain with sex decreased sexual appreciation and pain with sex goes for men and women. We treat a lot of men with sexual pain in a. Ability to reach climax, anything sexually related, inability to achieve penetration. For women, those are all pelvic floor issues, and then there's pressure. So feeling like something's falling out, feeling like you have a golf ball sitting on your rectum. Some men feel that's a usually, like a potential nerve symptom, feeling like you have a tampon falling out, feeling like you have a lot of pressure in the perineum. For women, a lot of women say, I feel like I have a tampon that's half in and half out. Those are sort of the major things. And then we have, we started talking about pain with sexual but there's pelvic pain. The tricky thing with pelvic floor pain is that you guys know this, sometimes the origin of the pain is at a distant location from where the person actually feels the pain. So for example, we get a lot of men that have pain on the tip of their penis. A lot of times that's referred pain. The psoas could refer pain to, you know, the genital area, so pain in the low back, pain in your toxics, pain in Brawl line, pain, hip pain, groin pain. Those could all be indications that something is going on with your pelvic floor. And really, what we do is we, we look at, we look at the root cause, right? We don't want to, we don't want to just treat symptoms and put a band aid on it. We want to identify what's causing the pain. Does that answer your question in a big way, yeah,

Dr. Spencer Baron:

in more ways than one. I remember, I remember studying many years ago about prolapsed uterus. Now that's after the fact, obviously. And there was always that device that, that little ring that they would put up into the right, the pestering, right? You're talking about the ability to do things before that actually happens. Yes,

Susan Winograd:

yes, yes. So for example, pelvic organ prolapse. A risk factor for pelvic organ prolapse is chronic constipation, constantly bearing down over and over again can cause a rectal prolapse. Um, you know, I, I years ago, I had a lady in and she was in taking a yoga class and downward facing dog, and her bladder prolapsed. That was a intra abdominal pressure management issue. So when we think about prolapse, we think about it in terms of whole body prolapse. Pelvic organ prolapse is a weakening of the connective tissue in the vaginal walls. Men can get a form of rectal prolapse. Also, it's not as common, but pelvic organ prolapse, when we look at it, we look at it as a postural control issue, a pressure management issue and a pelvic floor issue. So that's why it's so important for people to know how to use their core to know how to generate support from the inside out, to know that chronic constipation is a risk factor and can contribute to pelvic organ prolapse and that alignment may also play a role. I'm particularly passionate about women during pregnancy having pelvic floor therapy checkups, the way we do it in a whole body approach, because their bodies are changing so quickly, their posture is changing so quickly, there's so much pressure on their pelvic floor. And by simple education, we can help them learn how to manage pressure throughout their pregnancy, optimize their alignments as their center of mass is changing, and also that by simply preventing constipation, can help also so I wish, and the reason why I speak All the time do podcasts and how to podcast is because I typically treat people once they have prolapsed, and sometimes it's not avoidable. There are other risk factors, but I very often find that it either could have been preventable or the degree to which they're presenting with could have been mitigated. Do

Dr. Spencer Baron:

people that have hemorrhoids? Is that like an early warning sign because of weak connective tissue before? Like, because I don't, I don't think I remember hearing ever about rectal prolapse. Yeah,

Susan Winograd:

so it's very interesting that you asked me about because I. I had a meeting with a group of colorectal surgeons, and one of them said, Well, what do you do? And I started telling them what I do, and then he I said, we can also help people manage and prevent hemorrhoids. And he started laughing at literally, like, laughing at me. He's like, and then he's like, I'm done here. You gotta be kidding me. It was terrible. And the answer to that is, is that people usually get hemorrhoids when there's a lot of pressure down in the pelvic floor. They're straining a lot, or there's a lot of tension in the pelvic floor, so it's a very close vein, right? So if you ask a pelvic floor physical therapist, I believe we will all tell you, there's so much we can do to help hemorrhoids and potentially, potentially maybe even prevent them. If you ask a colorectal surgeon, they may give you a different answer.

Dr. Terry Weyman:

Hey, Susan, I'm gonna interrupt that for a second. When I worked with a hockey team, a very well known hockey team, there was like two or three of our players at the pro level that had hemorrhoids, it's very interesting that Dr Spencer brought that up because you would think these pro athletes were very strong in their core and their lower body. What would be your answer to the Why would these, these pro hockey players on skates, doing that, getting hemorrhoids?

Susan Winograd:

So the answer to that question is, I'm going to give you one hypothesis that could be but obviously, there's a lot of things that can contribute to hemorrhoids. They could be very constipated and just kind of like bearing out to evacuate, you know, stool over time. Usually hemorrhoids is not something that happens once. It happens when you repeat straining over a period of time. So it could also be, and I know professional athletes are strong. I've, you know, I've treated many professional athletes, and number one is that doesn't mean that they don't have tension in the pelvic floor. They may be strong globally. They're so good at compensating, you know, an athlete, you're right, is strong all over. So they may have some tension in their pelvic floor that they're able to compensate with other muscles in terms of stability. What I see a lot is that when people are young, they can compensate and compensate and compensate, and then it get you get to certain age. I mean, there's so much we could do to optimize our bodies, but I particularly find this in women that are in perimenopause and menopause, where there is a drastic change in hormone levels that things that they've been compensating for at a younger age start manifesting as they get older. So, you know, I think the bottom line is, is these, these athletes are are young, they're globally strong. They may be able to compensate or it may be a constipation issue. It may be an intra abdominal pressure management issue. But just because you're strong doesn't mean that you're constantly managing pressure during activities. So someone like that may be breath holding during things that require a lot of pressure. And when you breath hold. I always think of breath holding as holding onto pressure. Well, the pressure has to go somewhere, right? So when you constantly hold your breath and bear down, the pressure's gotta go somewhere, and usually it goes down. There's many reasons why they can have hemorrhoids, but those are just a few hypotheses. I don't know anybody

Dr. Terry Weyman:

listening to this show right now has to go to YouTube and watch what just happened. Yeah, I'm like, I'm not kidding you all. Oh yeah, I don't want I'm not gonna describe it, because I want people that now have to go to YouTube and just watch what just happened that was hilarious. The reason I even brought that up, I just want the audience already to not think of pelvic floor as a women's pregnancy thing or an old man thing. I want you to I want people start thinking it's just like we've had talks in the over the last few years about you have to think below the knee for everything above the knee to be healthy, you know, so I want people to start thinking globally instead of just myopically. And I thank you for that, Terry,

Dr. Spencer Baron:

let me ask you a question. Shoot, you do more like motocross and specialize that. I'm curious about what Susan has to say about the bike seat. And you know long distance riders, and you know guys that do you ever, have you ever had anybody complain about? You

Dr. Terry Weyman:

know, motocross and cycling are two different sports. So motocross, they hardly ever sit on the seat. So you would be talking about cycling and, like, two of the front stuff. And even mountain biking, they hardly serve ever since seat. So, so that's a little different. So that would be a potential nerve issue for cycling. Would be long distance cyclist, road cyclist, not anything else. Just to clarify that,

Dr. Spencer Baron:

yeah. Susan, how would you fix that?

Susan Winograd:

We do being proactive. So I'm very I believe we shouldn't tell people not to do what they love, but we have to optimize the way that they do it. So for someone that sits on a bike all day, I would first of all optimize their seating, make sure their body mechanics are good, but also I really make sure that, you know, there's a lot of pressure up on the pelvic floor when you're sitting on a bike all day, I would probably give them some pelvic floor relaxation exercises to do consistently to try to make sure that they're getting that healthy contracting, but also lengthening of their pelvic floor. And maybe, you know, maybe even checking in with the pelvic floor therapist to make sure that the tone of their pelvic floor is good. Everything's sliding and gliding the way that it should if they feel something, nip it in the bud. But always optimize. Know your body. Know how to do your sports and be proactive. Always balance out. If you're contracting all day, make sure that you're lengthening also throughout

Dr. Spencer Baron:

the day. So there's because I always have heard strengthening the, you know, pelvic floor muscle, but this is the first time I've heard someone comment on relaxing them. How would How do you relax a pelvic floor muscle?

Susan Winograd:

That's such a great question, and I'm so glad you brought it up, because we have people that have tension in their pelvic floor that needs to be released as much as we have people who need to strengthen. No kidding, yes. So we treat, I would say it's completely equal. So, um, yes, someone once told me this. Like, I don't know if it's true, but I think it's kind of funny. Um, it was another pelvic floor therapist. They're like, where do you think like, a type A personality came from? Where do you think we got that from? And I was like, I don't know. She's like, who's their tight asses, they hold tension? Yeah. So I was like, oh, that's like, really interesting. That makes sense. But in answer to your question, there are many ways we could release the pelvic floor. One way is manually, with massage. The best way is through the breath, the pelvic floor and the diaphragm work synergistically. Okay? So we have the diaphragm up here. We have the pelvic floor down here, right before the deep core system is made up of four muscles, the diaphragm, the pelvic floor, the deepest abdominal muscles, and then the deepest back muscles. They act like a hydraulic, almost like a hydraulic pump in our deep course, in in our body, okay, the entire system is led by the breath. It's fascinating when you inhale and your lungs fill with air. That growing volume of air in your lungs makes your diaphragm flatten and descend. In turn, your pelvic floor muscles will lengthen, broaden and relax. You exhale, the pressure is released from your lungs and everything shortens, recoils and engages. So with every breath you take, your pelvic floor relaxes and engages, lengthens and shortens, broadens and recoils. So I am obsessed with the breath. I think you can manipulate every system in the body with the breath, depending on what kind of breath you use. But for the the deep core system for the pelvic floor, deep diaphragmatic breathing is the best way to release and maintain that healthy length tension relationship of the college

Dr. Spencer Baron:

makes sense, right? Yeah, very much. So, yeah. So, you know, it's interesting, because my my girlfriend's a chiropractor, but she's up in Detroit. She told me about. Uh, one page, she does dry needling. She told me about one patient that she did dry needling on the perineum. I go for those who don't know what the perineum is, in a very crude way, in high school, they used to call it the taint. It taint your ass and it taint your balls. So it's right in between that area, yeah, and so she did it and successfully helped someone with some condition they came in with, but to put to do dry needling in that area. I have you heard of this?

Susan Winograd:

I do dry needling? Yeah, I taken all the dry needling courses, so I think that speaks to and I like, when I took the course, I'm like, Oh my God. Like, I think it really more speaks to the degree to which people are motivated to really get better. I don't needle the perineum really that much. I needle the obturators a lot. I needle the pacts of Jesus. I needle the iliacus a lot. I needle the psoas a lot. But I think it really speaks to people really want to get better. They want to get back to their school. They want to, you know, really optimize their quality of life. And it's really, really

Dr. Spencer Baron:

effective. Yeah, well, she helped that one person with the dry needling, and they kept, they referred a male and a female. I mean, that it all of a sudden became like an issues that people were talking about, is fascinating.

Susan Winograd:

It's so funny because I, you know, since I started dry needling, I started getting athletes that are like, my lots need to be dry needled, and my round boys need to and my traps needs to be I'm like, You know what my specialty is, right? And they're like, Yeah, let's forget about that. Let's stick to the waist up for me, but I need you, so I couple athletes that just heard about my dry needling and came to me for that. And it's amazing.

Dr. Spencer Baron:

That is so funny. I love that. Yeah, go ahead, Terry, were you going to say something? Well,

Dr. Terry Weyman:

it just makes so much more sense, because when I first met Spencer, he was such a type A person, and that ever since he met Karen, he's so much more relaxed. And I thought for something else. Now I understand, I

Dr. Spencer Baron:

swear she did not needle the

Susan Winograd:

Spencer comes to me, then he'll be like a Zen Buddhist. Oh yeah, I really get him to relax.

Dr. Terry Weyman:

Oh, absolutely. I mean, he's just been so trained in those last year and a half. So to answer so many questions, I'm just enjoying this so much, you know, I gotta, you know, while we're on this, on this topic, I will actually talk about, everybody talks about, when they think about pelvic floor, I think about Kegels, right? And, and, and people are going, Oh, Kegels is so old school, I mean, but that's what only people really know. And I think OB still this day goes, Oh, just do your Kegels, and you're fine, right? Can you elaborate on that?

Susan Winograd:

So I think that's so old school. Yeah, I first of all, let's just, let's just start from the beginning, right? So many things I want to say on that, I'll say it all. We just talking about Kegels, right? You can't just do Kegels. When I do a kegel, I'm talking I'm giving people a fit prescription. I'm giving them, you know, function, timing, interval, intensity, there are slow twitch fibers, and there are fast twitch fibers. So even when we do, when we do, give people a kegel program, we're giving them a very, very individualized program on how to do it, and we're making sure they do it right. Years ago, they did a study on how women did Kegels, and they found that 80% of women were doing it wrong. So I think to give people a blanket statement of doing Kegels is detrimental to their health. And number two, we all know that nothing lives in isolation, and when we're treating something, we can't treat it in isolation, especially with the pelvic floor, because we it works synergistically with the transverse abdominis. It works synergistically with the diaphragm. So when we see someone, we're making sure that each core component is working optimally individually, but we're also making sure that it's functioning optimally in coordination with each other. And then you want to take that to the next level and make sure that they're using their pelvic floor and their Kegels functionally in their gross motor movements. So many people get pain, hip pain, groin pain. And back pain because they're really not using their pelvic floor or their core. They're compen they're compensating with many superficial muscles, and over time, that's just not sustainable. So we need to teach them how to use their core in a way that's going to support the demands of the task we're asking it to do. So it's so much more. I'm not even going to say it's complex, because that's what we do all day, and people love it. I always tell people, I'm going to teach you to use your body in a way where you're not going to need to come to me. You're going to know exactly how to use your body in a way so you can do any movement. And it's so liberating. People feel so much lighter. They feel so much more supported. And I think the most common comment I get is, How did no one ever tell me about this? Right? Like, how would I not know about this.

Dr. Terry Weyman:

You know what? Susan, I love this, by the way, and thank you for that. I i have in the last week preparing for this, I've had two people, one male with prostate cancer that just got done, and a female, and both of them were jumping, either with grandkids or their kids, and they were leaking, and both of them were told, Oh, that's just common. The older you get, and I don't buy that. And then, oh, here, just do Kegels every time you're at a stoplight. Just pretend you're stopping that urine flow. And then when the stoplight goes, you're done. And just do it every time. Can you just give some practical knowledge for somebody listening right now that has been told that at what they can start doing right now before they can get to a specialist such as yourself?

Susan Winograd:

Yeah. Well, first of all, I want to just say that leaking at any age is not normal. It's common, but it's not normal. I want to tell you a really quick story from my practice. That's my favorite story of all time. I had this 80 year old lady who called me and she was hysterical. She's like, Hello. Is this? Susan Winograd, I tell this story all the time, so if you've listened to other episodes of podcast, you've probably heard it or been to one of my events.

Dr. Terry Weyman:

By the way, you're not originally from Florida. Are you? Can you tell me,

Susan Winograd:

I'm a transplant, but my husband is born and raised Floridian, so there are very few there have a stake in the state. But she called and she was like, Oh, this is Susan Winograd, you know what? I want to tell you, what happened to me? She's like, I'm a housekeeper. I'm 80 years old, and last week, I started pushing furniture to clean, and I started leaking. So Susan, I said, this is not happening. I went to my gynecologist and I told her what happened. And I said, What are we going to do about it. And her gynecologist looked at her and said, You're 80 years old. You should retire. And she said, Susan, you know what I said? I looked at her and I said, I didn't ask you for professional advice. And she walked out and she and she's like, can you help me? I was like, You're my kind of girl. Come on in. I saw her, like, three times. Her leaking wasn't even a pelvic floor issue, really. It was a pressure management issue. She was like, breath holding and not using her core, right? She loved her job. She loved the people she worked with. She didn't want to retire, she wanted to get better. So I tell this story because we cannot dismiss people. When people come to us for help, don't when they're having pain with sex, don't just tell them to have a glass of wine and relax. That happens all the time. People are leaking, don't tell them. It's normal. But what I would say is learn a little bit about natural you know, bowel mechanic, bladder mechanics. Make sure that you're hydrated. Make sure that you maybe avoid, start, start avoiding bladder irritants, which would be caffeine, alcohol, carbonated beverages, acidic beverages, those could really exacerbate leaking and irritate the lining of your bladder. And I would honestly say go to a pelvic floor therapist, because you really, really could be leaking because you're weak, and you could also be leaking because you're too tight. We know that a tight muscle is a weak muscle, so I have as many people that leak because they have way too much tension in their pelvic floor as women that are are, you know, weak and tight. I. About the same. And also, I a lot of women, you want to avoid two main bad habits. You want to avoid peeing, just in case, because that can get your bladder used to, giving you the urge at a much lower volume. I'm going to pee just because I'm going to be on a podcast episode. I'm going to CBS so I can pee. So if you're constantly doing that, you are training your bladder to give you an urge at a much lower volume. On the flip side, you want to avoid camel bladder. Nurses, shift workers, teachers, pharmacists. I've had all of those professions telling me that they cannot go to the bathroom for 12 hours. They're on a shift. They're in the classroom. They're in. You know, I had a male a male delivery woman, who came to me she was holding her bladder for 12 hours because she didn't want to go while she was delivering mail that can over stretch the lining of your bladder and decrease that sensitivity to urge. So just you know, honor strong urge, learn about bladder mechanics and avoid make sure you're hydrated. When people leak, their natural inclination is to stop hydrating because they don't want to pee, but it's actually the reverse a concentrated urine is very irritating to the lining of the bladder and will really give you more urgency and frequency. So keep hydrating, but make sure you see a pelvic floor therapist so that you could really resolve it for good.

Dr. Terry Weyman:

So besides breath work, with some exercises they can do to help with their pelvic floor, besides Kegels, if they're doing it wrong.

Susan Winograd:

So So with us, what we do a lot is, first of all, I ask people what they like doing. So if they're a yoga, if they're a yogi, I'll do a lot of pelvic floor engagement and strengthening in coordination with yoga positions. If someone is like or weightlifting, I will give them strength training exercises in coordination with their pelvic floor, because ultimately, we want to make sure that they're not only using their pelvic floor while strengthening in isolation, but also in functional movements. For some people that need a little more neuromuscular education, we can do biofeedback. So with biofeedback, we actually either put an internal sensor in vaginally or rectally or perianally, we could put electrodes, we attach them to a computer, and they can actually see on the screen their themselves engaging the pelvic floor and lengthening their pelvic floor. So for people that have a difficult time with that neuromuscular connection, we can do that. We also have electric stim not as we don't use that as frequently, but there are some situations where we do it's almost like an Nmes to help them recruit. But our treatments are very, very individualized. We don't have two people with the same plan of care.

Dr. Terry Weyman:

Awesome. You know you talk about your five pillars of health, okay, to make the pelvic floor strong. What are those five pillars? Can you give us a little overview of that? Yeah,

Susan Winograd:

so hydration is number one. Hydration, hydration is number one. Nutrition is really important. Movement is really, really, really important. We have a complete biopsychosocial approach. Is that what you were referring to, we have a complete biopsychosocial approach in our practice. So nervous system regulation is really, really important as well. And I the last one, I would say, is like self care and breath work.

Dr. Terry Weyman:

And just to throw it out there, because we've been hitting around it a little bit myth or truth, pelvic floor issues are only women that are pregnant.

Susan Winograd:

So I will dispute that by telling you that I started my career in reverse to most pelvic floor pts. I started my career with men. I treated only men for the first year that I only saw pelvic health, I just a door open for me. Someone who treated prostate cancer approached me, and I was really interested. I ended up developing a pre prostate surgical program for him, and then, you know, I felt like I was missing out on the other half of the population. So I expanded but men. Have pelvic floors, just like women, with the same issues that women do, and very similar anatomy, except for the external genitalia and, of course, the pelvic organs, but almost identical anatomy. So yeah, I one of the things that I'm proudest of is that we help men, because there are so many women's health centers. There are not as many places for men to get pelvic floor treatment, and they are our male clients are amazing, and they're so appreciative, and they're so grateful. And one of the things I'm proudest of is that we help men as well.

Dr. Spencer Baron:

You see young kids, not young kids. You see younger generations,

Susan Winograd:

younger adults. We don't see children with children. There are pediatric pelvic floor pts. We don't do pediatrics with with pediatrics. The largest component is really parent education when we're dealing with younger children, right? Because we don't do internal work on young children, and it's a lot of education for the parents, interesting, but there are people floor PTS, we don't do pediatrics in our practice.

Dr. Spencer Baron:

I remember, I remember growing up and hearing about, you know, kids that would become constipated because they would hold it in, because they had these anal fixations. And, you know, that was a that could have been a psychological thing from home.

Susan Winograd:

I think that comes a lot with kids. Like, you know, I'm pelvic floor. PT, so, like, when my kids were younger, I'm, like, if you got a poop in school, it's okay. You have to go. You shouldn't hold it in all day, right? I think a lot of times it comes into the plays, into those situations where a lot of kids don't want to go in public bathrooms. Yeah, we have to, like, educate our kids that it's okay, or even make a certain accommodations for them if needed, if they really won't go. But we have to teach our kids when they have an urge to honor it is that what you were referring to?

Dr. Spencer Baron:

That? Yeah, that that that's a lot of what I mean. Because those aren't, you know, muscular weaknesses, or those aren't physiological physical things. Those are more psychosocial

Susan Winograd:

there can be times when a child may have like a pelvic floor tension issue or a neuromuscular like in coordination or dysenergia issue, and again, there's a lot of breath work involved and a lot of education on the

Dr. Spencer Baron:

parent. Speaking of education, what kind of education is available out there to PTS or doctors that were are interested in engaging in this kind of in this environmental environment,

Susan Winograd:

there's so there's so much. I mean, I did mo most of my proper basic pelvic floor physical therapy, proper education. I did most of it on permanent wellness, which is a pelvic health Educational Institute. The APTA has tons of courses. I mean, it's very readily available, but I don't think that's enough. I've taken like our practice has such a diversified skill set. I've done craniosacral work. I've done total body balancing with the Diane rogio Center. I did all the dry needling work. I did a myofascial technique that's, you know, geared more toward infertility. You know, I feel like we really have to treat the whole person. I've done several courses just on how to integrate a biopsychosocial approach. How do we approach people that have pain but also have depression, anxiety, stress, catastroph worry, central sensitization, we have to address the nervous system, otherwise the body will never get better. So I think if you really, really, really want to help people resolve their symptoms and their issues for long term health, you have to get all the basic pelvic health training and coursework down. But don't stop there, because people need so much more.

Dr. Spencer Baron:

It's good to hear. You know, from that perspective, we're focused on just a area below the waist, and yet, there's so many ramifications to it. Just kind of like when patients come to Dr Terry, hey, can you just crack my spine? Well, I mean, there's so much more to find out about, you

Susan Winograd:

know, yeah. Well, for example, urinary urgency is an autonomically mediated condition that is a nervous system mediated condition. So. We have to treat both a lot of sexual function has a lot of nervous system component in it, right? We know that sexual appreciation is like this delicate Symphony between the brain and the body, and they both have to work together in an optimal way in order to achieve climax or in order to have sexual appreciation. So we really have to, like, kind of broaden, we have to have a global view of how we look at people

Dr. Spencer Baron:

you mentioned earlier, like psychosocial, you know? I mean, there's also, you know, I mean, over the years, I've always been fascinated. A patient will come in and they have low back pain, and they'll talk about it, and then, you know, it's, it's, it's so basic, you know, it was not a complex situation. But if you listen closely, you can hear that they have a problem with their their spouse, they they're almost looking for an excuse or a reason. Do you ever notice you know things that you know situations where maybe you should go to a psychotherapy or a family therapist or a relationship therapy?

Susan Winograd:

Yeah, excuse me. Um, there are a lot of times when I see people where I I have a great network of psychotherapists, because I can help them with their pain. I can also help them with a bio psychosocial approach within the scope of my practice, but I cannot help them process, you know, trauma. I cannot help them process emotions. So there are a lot of times where I say, I really, really think you're going to get the best results if you work with me and a psychotherapist at the same time, and there have been a lot of times where I say, I really don't feel comfortable working with you unless we work with a psychotherapist at the same time. Stuff comes up with pelvic floor. A lot of we bury a lot of emotion there, and a lot of times people have a, you know, sonato emotional release in therapy. And, you know, I love that, but I can't help them process that. I can help them with depression by giving them cardio exercises. I can help them with anxiety by giving them certain kind of grounding nervous system regulation. But if I feel that that stuff is stemming from emotions that need to be processed, that's not in my wheelhouse.

Dr. Spencer Baron:

I know our viewers or our audience is dying for me to ask you, has anybody peed on you.

Susan Winograd:

No,

Dr. Terry Weyman:

never. Audience is dying to know that.

Susan Winograd:

No, it never happens. I don't think anyone

Dr. Terry Weyman:

was I don't that question was not in my head.

Susan Winograd:

Not only that, Dr Spencer, but no one's ever asked me that you're the first one. Of course, he is,

Dr. Terry Weyman:

because he has dried kneeling his perineum right now.

Dr. Spencer Baron:

Everyone's wondering now whether anyone's peed on you. No, but I have people fart on me all the time. So that's it. We're done. Dr Terry, don't, don't even make believe like that never happened to you. Liar. Speaking of which, I had a professor from a university, a woman she was in she had abdominal surgery, and she told me, she goes, Listen, you know, be gentle. You know, when you adjust the low back. Let me tell you when, if you've ever been Susan, if you've ever had an adjustment from a chiropractor in the low back, that that chiropractor is way down there. You know, she blew a fart so bad that it practically burned my eyebrow up. No kidding, but it was so bad and she got so embarrassed that the only thing I could say was, listen, if you think that's bad, when you see my bill, you're gonna shit. No,

Susan Winograd:

that's funny. So it

Dr. Spencer Baron:

got her to laugh, and we moved on. But yeah, people pass gas all the time. Next time a patient passes gas, I'm sending them to you because that means they have a weak pelvic floor,

Susan Winograd:

yes, and I can send the bill that's going to make them shit.

Dr. Spencer Baron:

Right on. Wow, you got a good comedy show going on there. Yeah, right. So needless to say, Suze you. This is a specialty, and it is a specialty that has lots of legs to it. And I really think that, you know, one of the things I was going to ask earlier is, is it, you know, can I can adopt, what if somebody goes to their doctor or their, you know, and asks, you know, that you're going to get that, that answer, that, that age old answer, you know, the Kegel. But they really need to go to somebody so comprehensive that has many tools in their belt, right? I would imagine you would agree, because you've really made it a a a career in in that area and a very specialized area. Yeah,

Susan Winograd:

a lot of people think that a lot of our practice is like manual work, like internal, vaginal or rectal work, and that's really a tiny part of it. We have to be really good at orthopedics. We have to be really good at feeding the nervous system. We have to be really great myofascial therapists, you know. And also we have to be really great at finding the driver. There have been many times when people have come to me with pelvic pain, and I end up treating their foot or their ribs and a lot, and so I feel like, you know you really, really have to go to someone who's going to have your long term health in mind. Don't just fix the problem for now, let's, let's resolve this for good.

Dr. Spencer Baron:

Susan, you've been doing this for three decades. That's quite a bit of time. What was it that? What is it that drives you to achieve even higher education and more comprehensive what? As a healer, as an educator, what is moving you to this level?

Susan Winograd:

That's a great question. Well, first of all, I've been a therapist for 30 years. I've only done pelvic floor for 10 years, so I think I just am addicted to people's reactions when they feel good. It's just on. It's like the best feeling in the world. I think that it's fascinating. I Every step I turn, and I just feel like there's more to learn, and it's interesting. And I just, I love it. I truly feel like this is my purpose. So when you're living your purpose, why would you want to, you know, not strive to be better and better.

Dr. Spencer Baron:

That's fantastic. Well, we're gonna, we're nearing the end, but we always have to include our rapid fire questions in our show. There's five of them, I'm not sure, but you gotta click on, click on your feet. Rapid fire. All right,

Dr. Terry Weyman:

the Upper East Coast woman is coming out, yeah,

Dr. Spencer Baron:

go with it. All right.

Susan Winograd:

Love it ready.

Dr. Spencer Baron:

All right. Susan, if you if you could wake up tomorrow and master any hobby or skill, no limits, what would you dive into? Cooking? Really. I love cooking really. All right, we're gonna film a show at her house and have lunch after

Dr. Terry Weyman:

awesome. We're really good eater.

Dr. Spencer Baron:

Yeah, me too. Oh, question number two, if you were being sent into a deserted island for several years and you could choose only one book to bring with you, what would it

Susan Winograd:

be? The Bible? Oh, good. How come? How come?

Dr. Spencer Baron:

Nobody else has answered that that way, that that would make all the sense in the world. Very good. All right, so far, so good. Question number three, is she great at these answers? She's killing it, yeah. Question number three, when you're having a rough day, what's your go to pick me up routine,

Susan Winograd:

give my husband a hug.

Unknown:

Oh,

Dr. Spencer Baron:

that was great, right? I have

Susan Winograd:

breath work and I have go to strategies, but nothing makes me feel better, like a hug from my husband.

Dr. Spencer Baron:

I love it. I love that. She's great. I'm all granting over here now, yeah,

Susan Winograd:

30th wedding anniversary. Oh, we

Dr. Terry Weyman:

got our 29th on Saturday.

Dr. Spencer Baron:

Cool. You guys. Good for you. Question number four, complete this. The one thing I would tell every new parent about pelvic health

Dr. Terry Weyman:

is be

Susan Winograd:

proactive. Is

Dr. Spencer Baron:

she not the best?

Dr. Terry Weyman:

Yeah, absolutely,

Dr. Spencer Baron:

yeah, because

Susan Winograd:

come on, you got to do better. You can't peasy. You

Dr. Spencer Baron:

can't imagine the answers we get anyway, we'll go on question number five, last one, what is the one thing that always makes you laugh

Susan Winograd:

my grandchildren,

Dr. Spencer Baron:

especially when they laugh, right? Oh, that was. Great Suze. Thank you so much. Susan Winograd, this was a lot of fun. Fantastic show. It's so unique, and it's very, very informative. And you know, I'm sure our audience is going to be looking into the bottom half of their body a little more closer. Thank you, Suze. Thank you. Thank you for listening to today's episode of The Kraken backs podcast. We hope you enjoyed it. Make sure you follow us on Instagram at Kraken backs podcast. Catch new episodes every Monday. See you next time you.