Did you know that our pelvic health plays a huge role in our overall health? In this episode, we discuss the connection between our pelvic health and mental health. Mallory Willis, a Doctor of Physical Therapy, explains the essential role of pelvic health in our overall physical, mental, and emotional health. The mind-body energy system contributes so much to how we function, and that should be what therapists should explore. Mallory’s expertise allows her to help individuals change how they respond to stress. Tune in to this episode to find value in our pelvic health.
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Mallory Willis: The Important Role Of Pelvic Health In Mental Health
Mallory Willis is a Doctor of Physical Therapy and specializes in pelvic health. She lives in Colorado Springs and owns a practice there. She’s passionate about helping the community understand what pelvic health is and its important role in our overall physical health and mental and emotional health.
Mallory, welcome. It’s lovely to see you. Thanks for joining us.
Thank you so much for having me. I love your show. It’s an honor to be on it with you.
Thank you for that. I was hoping you could start us off by letting us know a little bit about how you got into the work you are doing and what drives your passion for it.
Since the time I was in high school, I knew I wanted to be a physical therapist. I was not exposed to pelvic health until I was in my graduate program at the University of Pittsburgh. It was there that they introduced us to pelvic floor physical therapy or pelvic health and if we showed interest in it, they trained us with their residency program. It clicked. It was like, “This is what people need. This is such an underserved population.”
A lot of people shy away from it because it is an intimate area of the body. It includes learning internal treatment of the vaginal and rectal muscles but it’s such an important part of the body. I felt like my personality matched what was needed to help people in this area. I received six months of mentorship and training and then graduated from that program knowing that’s what I wanted to specialize in.
I moved back to Colorado Springs where I grew up and worked for a few years for a private practice. I felt like there was a huge void in this city of care and people who specialize in this area. I started my business in 2022 to try to help facilitate some different programs and provide better access for people to know that there’s help out there for these types of issues.
My understanding is very few people understand the mechanics of that part of the body and its relevance to our stress levels, mood, and mental health. Can you give us a little primer course?
Especially related to the topics of your show, if you google a picture of the pelvic floor, you will see that it’s a bowl of muscles in the base of your pelvis. These muscles have four jobs. They control our urinary bowel function and sexual function, and then they are supportive of our organs. They are part of our core muscles.
When we have issues in these areas, it could be leakage, urinary retention, or constipation but a lot of times we see pelvic pain. It could be in the region but it could refer to their abdomen, hips, and back. These muscles are very tied to our nervous system. When we undergo stress or we are in a fight or flight response, they reflexively tighten. That’s how we are built.
It’s a more common area that we see. If someone has dysfunction in this area, their symptoms are usually much worse with stress. If you add the layer of trauma onto that, it gets very deeply intertwined with the body. We have to acknowledge the treatment of these muscles from all those aspects like their mental health, their emotional health, what they have been through, and how their body is moving from a musculoskeletal standpoint.
There’s an ancient wisdom about how when we go through something deep emotionally, it moves in our bowels. They used to talk about moving in the bowels and that tightness, tension, and carrying of stress that some of us do. Some of us carry it more up on the trapezoid muscles and in the chest but some of us carry it more in our lower abdomen and the pelvic floor area.
When you are going into the fight or flight response, you are getting ready for it. You are tightening up or tensing all kinds of muscles. We know about most of the others from the torso up. People don’t pay attention to this specific area of the pelvic floor. How do you help first diagnose or identify if there’s a specific problem in that area? How do you help people with therapy around it?
The muscles are inside our pelvis. We grow up with no concept of where they are. There are even muscles there that can affect how we move, breathe, pee, poop, and stuff like that. Usually, patients find pelvic floor therapists either by a referral from their medical doctor, which could be sometimes primary care but it’s usually a gynecologist, urologist, or GI doc.
There is a wave of people that there’s such a gap in knowledge because it’s not a new field but it’s very under-researched so people are not as aware of it in the medical system. Patients start googling. They find weird stretches on TikTok and then they seek out their pelvic floor physical therapists. They come in and are like, “Something might be due to these muscles because I have hit dead ends and every other aspect of my care.” However, one of us goes through their medical history and what they have been through like a typical medical exam.
To assess these muscles, we look at how they work with the body. If you imagine your abdomen like an enclosed canister, we look at the rib cage and the breathing. We look at the abdominal muscles and then we can do an internal muscle assessment either vaginally or rectally of the pelvic floor. When we do the internal assessment, it’s very gentle. It’s with one gloved finger.
We are testing for tightness and tenderness. We are seeing what the patient feels at each muscle we palpate. We might touch a muscle that makes them feel like they have to pee and it’s like, “That’s causing their urgency, not their bladder.” It could refer to their hip pain. After that whole assessment, we put it all together. Sometimes, people’s abdominal muscles are tighter than their pelvic floor and that’s more of the issue.
When we see the chronic stress and pain in this area, it’s usually we need to address all aspects or they are not going to see continuous improvement. It usually involves breathing treatment and exercises, abdominal massage and mobilization, and then internal muscle or myofascial release. I like to word it to people that I know this is scary and out there but it’s just muscles that are inside your pelvis.
If you strain your neck, you will probably get either a massage or see a physical therapist or a chiropractor. We have that concept that we would get at work on and it’s the same idea. It’s muscles that are intertwined with nerves and connective tissue that are connected to all of our organs and our hips. When it goes haywire, it can wreak havoc on our body because it’s so essential to our function. Patients who have trauma, that may be the cause.
When I have had people who have this, they find the trauma at the source or they are doing some stretch or release and all of a sudden, they are flooded with a memory of a trauma. That was going to be my next question for you. How well prepared are you and how well-versed are you in identifying and helping people work through if trauma is rooted in the dysfunction in the pelvic floor?
Early on, we did not get any training in this when I started going into this specialty. I realized very quickly when I was working on my own that if I did not acknowledge this, my patients were not going to get better and were not going to feel safe. I started to listen to them. That’s the best advice any medical practitioner needs.
Your patient will tell you what they need and what’s going on if you ask the right questions. There can be a series of when that comes up. Sometimes they fill out and they always fill out an intake form before I see them in person. Sometimes, there’s a space they can put if they have had trauma. It’s more open if we talk about it before I even touch them and I let them know that it can be related. If they get a memory or we are working on an area that they are not comfortable with yet, they tell me. We are not like, “No pressure. The patient is guiding the treatment.”
Sometimes, they come in for a different reason. Maybe a female with urinary leakage is unaware that she had trauma maybe with some childbirth or sexual abuse when she was a kid. It never meshed in her head. As we start working, you can see the confusion and watch their eyes like, “Some things are coming up.” We talk about it.
I try to lay it simply like, “This area of our body is connected to our emotions and what we have been through.” If it seems like something very intertwined that they need more therapy, then I refer them to a mental health therapist or even EMDR and stuff to work. Sometimes people are in that while they are actively going through physical therapy.Our body is connected to our emotions and what we've been through. Click To Tweet
EMDR is a very popular and well-researched effective technique for helping people resolve the effects of past traumas. It’s non-invasive. It stands for Eye Movement Desensitization and Reprocessing and it’s been around for decades.
It’s very effective with having a history of trauma and pain in this area. I acknowledge where my lane is. My job is to help your body work and your muscles and joints but I have to acknowledge that this is involved. If you want to talk about that with me, I am open but if you feel like you need someone to take you further, then here’s a good list of people that I trust that I work with.
That’s how I approach it with my patients but it gets deep and emotional. As a practitioner, if you are not aware of that or careful, it can get heavy very quickly. We’re seeing patients in a row who have had trauma. Especially in this city, we are surrounded by four military bases and many active-duty independents have experienced some type of trauma.
When I learned to go into it more of assuming that there’s something that’s happened in their life that’s influencing this area, it becomes a lot easier to start to see the big picture of what this patient is experiencing and what they need. The internal and manual treatment is a huge piece of it but if we don’t leave space to talk about the emotions and the experiences they have been through, then they are not going to fully recover. Their body is not going to release that stress response that it’s holding.
I remember the breakthrough that happened when people in my field of psychology and social work therapy began to open awareness of the effects of trauma. It’s not that many years ago that people started questioning, “Has there been trauma in your life? How would you define that?” We help people understand that a seemingly innocuous event to one person might be downloaded as a very traumatic event by another. Listening and learning to ask good questions is a critical part of not only the assessment but also the treatment.
I was reading one of your episodes and I have learned other people say this too but exactly. It doesn’t have to be you were in a war, you were sexually abused, or you had a traumatic birth. Those are the big ones we see. It could be a traumatic experience with a women’s wellness exam like a pap smear. It could be tampons. It could be falling on your tailbone and ruining your sports career. Anything in this area can manifest. It could even be not related to this area. I have had patients who have had maybe a back injury or something and then maybe a deep grief, like a family member passed away. Their gut and pelvic floor shut down. It’s tricky. We got to go through the process to find it.
One of the things that we used to talk about with people is that in this mind-body energy system, we all have areas in which we are naturally strong and somewhat weaker. One of the ways we used to talk to other people is if you put some people in a stressful situation, they might develop an ulcer. If you put another person in that same stressful situation, they might develop migraines. If you put another person in a stressful situation, they might develop irritable bowel syndrome.
Think in terms of even this situation would not be labeled traumatic by 1,000 other people and it strikes me at a critical time in my life. Let’s say I’m right here after puberty has begun and I’m still searching for my role in the world. I have a crush on somebody and they say, “Ew,” when they see me. My response to that recoil and that fight or flight.
If I have got difficulty with my abdomen, there’s a weak spot there or some hernia that I had from a sports thing that’s right on the cusp of being a hernia, that spasm of muscle and contraction can cause a disruption there or that tension can get locked in there whether it’s the pelvic floor, my shoulder, or my abdomen.
Awareness of that is so important for the therapist, whether it’s a physical therapist, psychological, or sociological therapist, to help people and educate them. We aren’t looking for, “Did you see somebody get shot in front of you?” We are looking for what you downloaded through your life experiences that might be stuck in there with a negative meaning about you.
Every time it gets resonated into activity, that part of your body tenses or loosens in what is potentially unproductive as part of a functioning pattern. You might have urinary leakage, encopresis, or constipation. No matter what the other professionals would tell you to do related to diet or medication, it doesn’t seem to resolve. Let’s turn and start exploring this mental emotional or energetic connection.
That’s such a good explanation. It can be held anywhere in our body. It’s not that the response is wrong. That’s what I love about incorporating nervous system down training as I call it, decreasing the fight or flight response. We need that activated. It’s not wrong that your muscles tighten but then they need to relax.
It’s like keeping your hand on a hot stove. It feels hot but if you keep it there, you are going to get burned. We don’t recognize our movement patterns and tension-holding patterns as dangerous. Sometimes it takes months to years for the symptoms to manifest and then people are like, “What’s wrong with me? Why can’t I go to the bathroom?” We uncover all these layers of things.
If we are doing that good private investigator questioning and reading, we start to uncover meanings the person has downloaded with this tension or dysfunction in the physical system that even the individual wasn’t aware of because it happens in a heartbeat and so quickly. It gets lodged in what we would call the subconscious or unconscious. I’m not walking around thinking of it and yet when it gets activated and it tightens these muscles or it loosens these other muscles, it has a bad impact on me.
I try to word it to patients especially if there is still inactive stress in their lives. “I can’t change your stress but I can help you change how your body responds to it.” That makes them better. There’s a partner in the process. It’s not like, “I’m not here to fix you. I’m here to help you through this journey and get to know your body.”
Many of these patterns aren’t bad. They are an automatic response to try and protect or help us stay functional in a certain way. It’s just that if they get hooked up with a negative belief about myself or a lack of feeling of safety whenever it gets resonated, then I’m stuck in a loop that is unproductive. Something that my body originally did to try and be productive and keep me safe has become unproductive as a pattern.
Uncovering that and helping the person relax through it and attribute a different set of coping mechanisms to that issue and a whole different meaning to it can be life-changing for people. What’s the typical course of treatment when you have someone referred to you and they have issues in their pelvis? How long does it take? What follow-up do you need? What exercises ongoing do you give people?
It depends a little on the person but the most typical is about 2 to 4 months of therapy. Due to a chronic pain condition or something like endometriosis, chronic prostatitis, or interstitial cystitis, like a disease process, we can’t change but we can help their body calm down around it. That’s a different category. For a typical pelvic floor patient, maybe visit or have an appointment every 2 months.
That’s at least the model I see people. I see them for an hour. It’s usually a combination of manual work. I work on their rib cage, abdomen, internal muscle release, and then retraining. We help their body release the tension they are holding in the muscles that’s with the internal treatment and then retrain it the right way. How are they supposed to move? What are your hips doing? Is your pelvic floor compensating for hip weakness? Stuff like that. The end of the session is usually some type of exercise.
If someone is in a lot of pain and has a lot of tightness, look more at some yoga-based movements with specific breathing. If we have got that pain cycle worked out of them and they are starting to hold the mobility that we have gained, then we are going to look more towards strengthening and building resilience in the body. It becomes very functional. There’s a part of relaxation. They need to chill and get to be worked on.
If their pelvic floor is too tight and they are not responding to treatment or they are getting sore from it like a little achy and stuff, I will go to their neck. We could get on a rabbit trail of the neck related to the pelvic floor but that helps calm their body down. It accepts mobility better. Through my system, they have a specific program, whether it’s breathing, stretching, or strengthening exercise that they are doing a few times a week at home to help keep their mobility.
I also try to give them functionality. It’s not like, “Go do these exercises for 30 minutes.” It’s like, “When you are driving and your kids are screaming, you can do this in the car.” It’s easy little things that are check-ins to start to change the body’s response. Once we can make it functional, they get better so quickly. That’s the fun part of individualizing it for every patient.
Help me understand what you mean when you say, “Once we can make it functional, they get better so quickly.” What is your definition of functional?
It is what directly applies to their life. If one person is on 4 miles of their runs, they are getting horrible pelvic pain. It’s like, “How do we help the run?” That’s what they need functionally. For someone else, it could be a pain when they stand up out of a chair or leakage when they stand up and get out of a chair.
If they are driving in the car with the kids, the kids start acting up, and they start feeling something uncomfortable, then you give them a way to remain more fluid or functional in their daily life when the symptoms would appear. Is that what you mean by functional?
Yes, like practical for their life. Not like, “You have to wait until you can be alone. Lay on the floor and then do it.” It’s more meaningful to them. They get better quicker because they are doing things they enjoy. It’s like, “What do you want to get back to in your life?” With these bowel and bladder conditions, a lot of that is the ability to travel and do things. They are bound to the bathroom if they have IBS. I might have to go to the bathroom seven times in the morning. That can be a big deal of calming things down so they can go do things with other people and that brings so much back socially and stuff.
When you talk about getting things to be functional, I’m thinking about being active at the moment as I’m living my life and interventions that I can apply without having to call you for a session or get to a private space and lay on my floor.
The basis of retraining the pelvic floor is through breathing and two mechanisms. The diaphragm, when it moves our breathing muscles, talks to the pelvic floor through pressure. When it moves up and down, it signals the pelvic floor to move naturally. Your pelvic floor is supposed to move like an inner little trampoline and be springy and reactive, not clenched tight. The concept of being tight and doing Kegels is not functional.
When we retrain breathing and then they can do that anywhere, it signals the pelvic floor. As we know, the vagus nerve runs down the spine. If you can control your X with your breathing, that helps put us into more of that parasympathetic, resting, calm, nervous system tone. They call it like we are using your breathing to hack into your pelvic floor.
If you take a breath, get centered, and think about this, what’s an area that we have already covered that you want to highlight or something about your work that we haven’t even touched on yet that you want to provide information to us on?
The biggest message I want to help people know is there’s help in this area and muscles that are part of your body. We should have as much knowledge and autonomy about these muscles as we do with our back strength, squat, and stuff like that. It’s so related to quality of life. The number of people who suffer for decades without knowing that they could get treated relatively simply breaks my heart. They don’t have to suffer.
There are not as many pelvic floor therapists as there are general physical therapists. It’s slightly hard to find them sometimes but my message to people is no matter what you have been through, if you are dealing with gut issues, urinary, bowel issues, sexual dysfunction, or any type of pelvic pain, it’s fine to get this area looked at and it will help your quality of life.If you're dealing with gut issues or pelvic pain, get this area looked at, and it will help your quality of life. Click To Tweet
There are these two big pieces that come to my mind. One is awareness or education about this area and how it is closely tied to our sense of self and our ability to function. Most of us are so fortunate in this area that we don’t have to worry about where we are going throughout the day so we can be two minutes from a bathroom, yet some of us have that issue.
The second area is a shame. If we can destigmatize this, we can let people know that for the most part, there are all kinds of things that can happen related to our stress management, resolution of trauma, our physical health, and strengthening certain muscle patterns. If we can help that become common knowledge, then even if people don’t have it, they can start spreading the word about it.
Even though I don’t have that issue, as a therapist, I can start tuning in when I hear somebody talk about something and say, “I’m not an expert in it but I try to explore this.” Rather than saying, “It’s your anxiety and we need to help you with your anxiety.” That’s all I know. If I as a therapist haven’t been exposed to this work, the mind-body energy connection, the physical therapy, and the things that happen on the massage table where people tap into traumas, and I was never aware of that and I think, “I’m a therapist. I talk to people about what’s happening in their mind,” then I have very limited utility, especially for this type of area.
We need to acknowledge that it goes both ways. Our anxiety and stress can create physical issues but we can have physical issues that amplify stress and anxiety. We are in a tough loop. We need people on both ends of this to be able to meet the patients where they are and give them the resources they need.
Many times, they think it’s in their head. A lot of traditional medicine doctors don’t understand. Their training is in other stuff. They do not have musculoskeletal deep expertise and how the connective tissue, blood flow, and lymphatics influence this area. It’s fine. That’s physical therapy’s realm. That’s our highway. They have a different lane.
When patients start to feel like they are crazy and they have had every test in the book, everything comes back negative, and nothing is explaining their pain, their stress and mental health becomes so compromised and fragile. If they knew sooner like, “It’s not shameful. Let’s get these muscles checked and see if it’s related,” people feel validated. They don’t feel crazy and their anxiety goes down.
You mentioned in our pre-interview talk about building your business and trying to get the word out about this. I’m hoping that an interview like this will get in front of more therapists. I’m also hoping that in your marketing plan, educational plan, and outreach plan, you are going to be working to educate therapists as much as the physical doctors because it is so important.
Many people as therapists hear from people who are stuck in, “I have stomach issues. I have anxiety issues.” They are not letting you know that they affect their stomach, bowel, and bladder. The therapists hear about this sometimes far more often than the medical doctors. To have them have the awareness of this work would be valuable.
That’s a very good reminder. Things like that cross my mind but then I forget how many more patients they see. That point of contact can help so many more people than me trying to talk to patients about it.
If you can do an in-service for a therapy group, that would be phenomenal.
That’s a great idea. I love the interprofessional circle. There are so many pillars of health we need to address and we can’t do it all by ourselves.
It’s great to have specialists who have this ultra-refined knowledge about a particular thing. Yet if you don’t have the integration of that knowledge with other systems, you can go down a rabbit hole and miss the whole point of what might be connecting these different systems.
I thank you so much for taking the time to share with us and our readers. If people want to find out more, what is the best way for them to learn about you and the work you are doing?
My business is called Peak Pelvic Health. My website is PeakPelvicHealthCO.com. We are on Instagram and Facebook. We have a blog that talks about different topics that we are building out for better patient education and seeing how we can help the community.
This is wonderful. It’s a delight to learn about you. I have to send a thank you note to those who got us hooked up together. Thank you so much for sharing time with us. I look forward to a follow-up call in the not-too-distant future.
That sounds great. Thank you so much. It was an honor to be here.
Thank you. Take care.
About Mallory Willis, PT, DPT
Mallory Willis is a Doctor of Physical Therapy and specializes in pelvic health. She lives in Colorado Springs where she grew up and also owns a practice there. She is passionate about helping the community understand what pelvic health is, and how important it is to take care of our pelvic health.
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