The Art of Pilates: Classical Pilates, Authenticity & the Future of the Method with Olga Tamara

Season 3 Episode 23 · August 2026 · 67min

Listen to the full Spotify episode here

Most of us assume a "weak" pelvic floor is a loose one — but as pelvic health physiotherapists Genia Barmakov and Cherry de Crespigny reveal, a pelvic floor can just as easily be too tight, gripping and overworking until it causes the very same symptoms as weakness: leaking, pain, and dysfunction. It's a distinction that changes everything about how you should be training your core and your clients' cores. In this episode, I sit down with Genia Barmakov and Cherry de Crespigny to talk about what your pelvic floor is really trying to tell you — from pregnancy and childbirth to menopause, athletes, and the everyday habits quietly shaping your pelvic healt 

ABOUT Genia Barmakov & Cherry de Crespigny  

Genia Barmakov is the Founder and Principal Physiotherapist and Acupuncturist at Health Canvas Clinic in Caulfield South, Melbourne, with over 20 years' experience in women's and men's pelvic health, continence, and perinatal musculoskeletal care. She holds a postgraduate qualification in Continence and Pelvic Floor Rehabilitation and a Master's degree in TCM Acupuncture from RMIT University. Learn more at healthcanvas.com.au.

Cherry de Crespigny is a Consultant Physiotherapist and Pilates Instructor at Health Canvas Clinic, specialising in pelvic health, bowel dysfunction, and pregnancy and postnatal care. She holds a Postgraduate Certificate in Pelvic Floor Physiotherapy. Learn more at healthcanvas.com.au.

WHAT YOU'LL LEARN IN THIS EPISODE

• You'll learn that a "weak" pelvic floor isn't always loose — it can also be overactive and tight, and both extremes can cause leaking, pain, and prolapse-type symptoms.
• You'll understand why urinary tract infections in elderly people can show up as sudden confusion or cognition changes rather than painful urination — a sign worth watching for in ageing relatives.
• You'll find out why sitting upright (or hovering) on the toilet makes it harder to fully empty your bladder or bowel, and why leaning forward with your calves relaxed and feet supported is the better position.
• You'll discover that repeatedly straining on the toilet can stretch the nerves around the pelvic floor over time, creating a cycle of increasing weakness.
• You'll learn that 50–80% of high-level athletes experience some form of pelvic floor dysfunction, often from overactive pelvic floor muscles rather than weakness.
• You'll get practical guidance on when to see a pelvic health physio during pregnancy: ideally before conceiving, again once energy returns after the first trimester, and immediately (rather than waiting six weeks) if any symptoms appear after birth.
• You'll understand how chronic stress and past trauma can cause the pelvic floor to tighten protectively, and why becoming aware of pelvic floor tension is often the first step to resolving it.
• You'll learn what makes an exercise "pelvic floor friendly" — breathing normally and engaging the pelvic floor to match the load, rather than bracing, holding your breath, or racing through reps.
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FROM THE EPISODE

"Weak may not necessarily only mean loose. It can also be an overactive pelvic floor, tight pelvic floor." — Genia Barmakov

"If your nervous system's heightened, you tend to carry more muscle tension anyway... we call them the bouncers of the pelvis." — Cherry de Crespigny

FREQUENTLY ASKED QUESTIONS

What is pelvic floor dysfunction? Pelvic floor dysfunction is when the pelvic floor muscles aren't tightening, relaxing, or coordinating properly on command. It can show up as the muscles not being strong enough, not relaxing when they should, or not contracting quickly enough for things like a cough or sneeze. The result can be incontinence, pain, constipation, or bladder sensitivity.

What are the signs of a weak pelvic floor? Common signs include urinary, bowel, or wind incontinence, a dragging or heavy sensation in the vagina, and in men, rectal prolapse. Importantly, "weak" doesn't always mean loose — it can also present as an overactive, tight pelvic floor that still causes leaking or pain.

Do men have pelvic floor issues too? Yes. Men have the same pelvic floor structures as women (minus the vaginal opening) and can experience constipation from a pelvic floor that won't relax, or pelvic pain from one that's too tight. Prostate surgery and age-related prostate enlargement can also affect urinary function and require pelvic floor rehabilitation.

Should I see a pelvic health physio before or after having a baby? Both are valuable. Seeing a physio before you're even pregnant lets you address habits early and build a foundation of exercise. If you're already pregnant, a check in the second trimester is useful, and if you develop any issues postnatally, you should be seen straight away rather than waiting for the standard six-week check.

Is leaking urine after childbirth normal? It's common, but Genia and Cherry are clear that common doesn't mean normal. Some temporary loss of function can occur due to stretching, swelling, or nerve compression during delivery, but it should improve with time and appropriate treatment — it's not something to just live with.

Can highly active people or athletes get pelvic floor problems? Yes — an estimated 50 to 80% of high-level athletes experience some form of pelvic floor dysfunction. High training demands can lead to an overactive pelvic floor, particularly in younger women doing jumping, running, or dancing sports, and it isn't necessarily linked to fitness level.

How does menopause affect the pelvic floor? Dropping estrogen levels reduce the elasticity and plumpness of pelvic connective tissue, which can lead to prolapse symptoms, urinary urgency, and increased susceptibility to UTIs. These changes, called genitourinary symptoms of menopause, can begin in perimenopause — up to ten years before periods stop — and are manageable with the right treatment, including topical estrogen creams or pessaries prescribed by a GP.

When should a Pilates instructor refer a client to a pelvic health physio? Cues include a client disclosing bladder, bowel, or pain-related symptoms, needing frequent toilet breaks during class, a recent surgery in the abdominal or pelvic region, or simply not responding to exercise modifications as expected. Both guests describe it as partly an intuitive "gut feeling" built from knowing your client well.

FULL EPISODE TRANSCRIPT

Lightly edited for readability

Louise: Welcome to The Art of Pilates. I'm here today with Genia and Cherry from Health Canvas. So Genia, what inspired you to create Health Canvas?

Genia: It's been a long dream of mine to have a space where we work with like-minded people — and we're very lucky to have clinicians who are like-minded. We look at health from different aspects, different sets of skills we can contribute, looking at things outside the square sometimes. It's a place where people can come in comfortably, be informed, exercise, learn how to optimise their health. And it's also a place where they can come with kids, come with their partners. It's a welcoming place of wellbeing — whether that's physical or emotional, it all comes together.

Louise: And where did the name come from? Health Canvas — I was driving here going, that's an interesting one. Where did the name Health Canvas come from?

Genia: So I love art. I really do. You've probably noticed we've got some canvases on the walls — I love original art. But I also look at health as a painting in a way. When someone comes in with an issue, I always think about the layers of their story. It's not just the pain in the back — when did it start, how's your sleep, how's your diet, what do you do for exercise? It's a layering effect. So if somebody comes in, think of it as a white blank canvas, and we can layer on the habits, the activities, the thinking about health, and create wellbeing. That's what I was thinking about when we came up with Health Canvas.

Louise: There are so many facets to it. And Cherry, what do you most love about working with pelvic health?

Cherry: I think it follows on from the health-as-a-canvas idea — so many things influence pelvic health, from emotional life history as well as the physical. It's often a privilege that people are sharing quite intimate details with you, and it's very rewarding. You can make big differences, and it's rewarding that someone chooses to share and has your confidence.

Louise: Because you'd be so nervous before going in to see someone for an assessment.

Cherry: Yeah. And if you can get to the end of seeing someone and they say, "Thank you, I felt very comfortable — I was worried before I came in, but that actually felt really comfortable" — that's very rewarding.

Louise: That's a big win. And Genia, why is the pelvic floor so important for overall health and wellbeing?

Genia: Because the pelvic floor is a really important structure. When we talk about pelvic floor, we're not just talking about the muscles — we're talking about the organs within the pelvis. You've got your bladder, your bowel, your fertility, your reproductive and sexual organs. So it's a really big part of overall wellbeing. When bowels don't function well, it affects our mind, our overall day, how we feel, how we sleep. Same with the bladder. And don't underestimate the pelvic floor muscles as part of your core — as soon as you get up, your core switches on the right way. It's in every single moment of your day. It cannot be underestimated.

Louise: It's kind of a sign of health. My partner and I went to this medieval festival and they had jars of urine, different colours — they even tasted the specimens, that's how they diagnosed sicknesses. But also that mind connection with the gut and the pelvic floor — is it urinary incontinence, like with the elderly?

Genia: If you have constant urinary tract infections, your cognition can go. It's one of the signs in the elderly — if overnight the cognition changes, that's one of the things we always think of, because a UTI can be without other signs. It doesn't need to be painful urination. It can just be changing cognition.

Louise: Oh wow. And even dogs, when they do a poo, they're so happy after. It makes you feel so good — like, "I did the best poo ever."

Cherry: On the Bristol stool chart, a number four is the Goldilocks poo — not too hard, not too soft.

Louise: So Cherry, do men have pelvic floors as well?

Cherry: Yes, they do. Women have a superficial layer just below the surface involving the sphincters of the back passage, vagina, and urethra. Men have the same thing except just a back passage and a muscle behind the testes. Both men and women have levator ani, a hammock of muscles about an inch inside, which lifts the anus up and forward. Men can have the same pelvic floor dysfunction issues — constipation because the pelvic floor's not relaxing, or pelvic pain because it's too tight. Their urinary system is a bit more secure — they have a longer urethra and a prostate gland that helps keep pressure in the urethra, so they're less prone to urinary incontinence, and they don't give birth. But they can have issues from procedures like prostatectomies or TURPs — a resection of the urethra — where things can become more open. They may not be aware they even have a pelvic floor, but they still need to learn how to use it.

Louise: Is that mainly cancer treatment, or for prostatectomy?

Cherry: Yes, or as men age, their prostate naturally becomes enlarged — it's called benign enlargement. It gets to a point where it's obstructing or reducing urinary flow, and there are procedures to open the urethra to let that pass more easily.

Louise: And once you've had surgery like that, do you need to do exercises to get it back to functioning properly?

Cherry: Definitely, after the prostatectomy and other procedures — it's a bit symptom-based, depending on what's happened and their symptoms following it.

Louise: It's so full-on. You always think of women with pelvic floor issues. How do men find you? Women are always talking to each other — "you've gotta go see my pelvic health physio."

Genia: I've seen a couple of husbands of our patients too. A lot of the time it's word of mouth, but with guys it's often a referral from a specialist when they start having issues, and generally the issues have been going on for a while before they get really bad. We work with quite a few specialists who refer to us. It's evidence-based to see men before their prostate surgery, so they can learn how to do pelvic floor exercises properly, and address any habits they've picked up that may not be good ones. After the surgery, we guide men through the recovery process, which may take up to 12 months.

Louise: What are some of the bad habits? My main complaint of bad habits in men is they don't wash their hands after the toilet.

Genia: Probably more the bladder and bowel habits are the main two things. If they've got a tendency to go "just in case," that might indicate a bit of bladder urgency, or if they have a history of constipation we need to get that under control — you don't want to have pelvic surgery and then be straining immediately afterwards. And sometimes prostate surgery, because it sits just below the bladder, can make an already-sensitive bladder a bit worse afterwards. Even basic things we take for granted — like drinking habits — matter. When we ask men what they're drinking...

Louise: Oh my goodness, yesterday — Diet Coke and milk.

Genia: Soft drinks — even without sugar — people with sensitive bladders can really feel the impact of soft drinks.

Louise: What about coffee? I drink a lot of coffee.

Genia: It depends who you speak to in our clinic, but it's not everyone who reacts the same way — it also depends on the amount and strength of the coffee, and what else you're drinking. As long as you're well hydrated overall, there are many benefits to coffee — I'd never tell anyone to give it up. It's a hard one.

Louise: So Genia, what are the signs of a weak pelvic floor?

Genia: Some common signs are incontinence — urinary, bowel, or wind incontinence. In a woman it can be a feeling of dragging or heaviness in the vagina. In a man it can be rectal prolapse. Now, we think "weak" means loose, but weak may not necessarily only mean loose — it can also be an overactive, tight pelvic floor. And then it can become a source of pain.

Louise: Can a pelvic floor be too tight as well as too weak?

Cherry: Yes — it's like it's gripping on to try to hold. Sometimes we see a woman with something like prolapse — a weak and lengthened pelvic floor and connective tissue in the front part — compensating by being too tight through the back. Or someone very hypermobile, whose pelvic floor is working a lot harder to compensate.

Louise: I wanted to ask about hypermobility — if you're loose through the body, what happens with the pelvic floor?

Cherry: My understanding is the thoracic area and the pelvic floor seem to be the ones trying to hold you together while everything else is flying out everywhere.

Louise: So if you're weak and tight, and you're straining to do a poo because everything's tight — does that weaken the pelvic floor more, because you're pushing out against tight muscles?

Cherry: Yes. Repeated straining can cause lengthening of the nerves around the pelvic floor, which leads to a cycle of even more weakness — it becomes a chronic pattern.

Louise: What about when it's really hard to feel if you're working the pelvic floor — do you get people who feel like they just can't feel those muscles?

Cherry: Absolutely. It can be a combination of things. We have nerves around that area giving us signals, and different sensations reflect the messages those nerves pick up. But you're right — sometimes, in situations where someone has had a traumatic experience, they may block out that part of the body. It's an emotional disconnect. We often have to be very resourceful in finding ways of reconnecting those areas again.

Louise: That must be really hard.

Cherry: It's challenging, but it's a great challenge — especially when things start to work. If we're assessing someone who can't relax their pelvic floor because they can't feel it, and two weeks later they come back and you get a flicker — that's exciting, because it means change is happening. As long as you're working together with a patient and getting those little gains, it's really rewarding.

Louise: So Genia, what are the common signs of pelvic floor dysfunction that people often ignore?

Genia: I think we've kind of accepted that if you've had a baby — or three or four babies — a little bit of leakage is normal. It's not. It may be very common, but it's not normal. When I've had my babies, "I can't jump on the trampoline anymore" — that's not normal, especially if it's something you're missing out on with your kids. I think we should try to address it. Stress urinary incontinence, especially when it's just a little bit and you don't need many pads a day, tends to become accepted, unfortunately. Other conditions that are common and accepted are things like urinary frequency — "oh, I just go all the time, this is just me." If someone goes to the toilet 10, 12, 15 times a day, that's a considerable amount of time spent — and thinking about — the toilet.

Louise: Has the bladder shrunk down? Why is that happening?

Genia: Most of the time the bladder doesn't shrink down — a lot of the time it's a behavioural change that happens, but it becomes so physically palpable that it's hard to get your head around. It's more of a wiring issue, a brain rewiring. Our bladder signals and our brain are in a constant two-way conversation, and our higher brain often helps to inhibit things. If that's a little off, you can get very strong signals that you need to go even though your bladder's not quite full.

Louise: So Cherry, what is pelvic floor dysfunction?

Cherry: I guess it's any symptom or bother relating to the pelvic floor not working properly. Any muscle in our body needs to be able to tighten and relax well on command, and be coordinated. The range of pelvic floor dysfunction can be due to the pelvic floor not being strong enough, not relaxing properly, or — like with stress urinary incontinence, when you cough or sneeze — the pelvic floor needing to contract with power suddenly. If we don't have that coordination, or the endurance to hold a full bladder, that's dysfunction. If it's holding more tension, it can create pain, constipation, and even bladder sensitivity.

Louise: It's so interesting how one part can be tight and the other loose.

Cherry: Yeah — every person is like a puzzle you're putting together, all the different symptoms.

Louise: So Genia, what are the most common pelvic floor conditions you see in your clinic?

Genia: We see everything within the pelvic floor realm, because we're pelvic health physiotherapists. We may be seeing urinary or faecal incontinence, urgency or stress incontinence, pelvic organ prolapse in women and men, and patients with pelvic pain — ranging from someone young with pain associated with periods and endometriosis, and pain with intercourse, to women during pregnancy and postnatally. We're also seeing men and women with bowel dysfunction — Cherry's our guru on bowel — like constipation, which everyone thinks is normal but isn't. It's when it's really impeding their life that they come to see us, get a thorough assessment and advice. We also see men post-urological surgeries or with urological conditions. We see quite a variety of pelvic floor related conditions.

Louise: With pregnant women, can you help them relax their pelvic floor to have a baby? It always fascinates me — how does a baby even come out? Are there techniques you use to train women for that?

Cherry: The biggest thing early in pregnancy — we often don't do an internal check in the first trimester, but in the second trimester it can be useful to get a pelvic floor assessment and stay connected with your pelvic floor from then on. Hypermobility shows up a lot in pregnancy because your joints become more lax from hormonal changes, and if you're not connected to your pelvic floor, with these massive weekly changes, you can become disconnected — not knowing how to contract it, or holding tension in it. So connecting with pelvic floor exercise — being able to contract and relax, and staying active during pregnancy — helps you stay connected with your muscles.

Louise: And then you won't get so constipated as well.

Cherry: Yes. Later in pregnancy we might teach perineal massage, where a woman uses her finger to connect with the muscles and gently stretch the tissues, similar to what happens during a vaginal delivery — but also connecting with how to stay relaxed in the muscles rather than tightening up.

Louise: Because I always think about the whole idea of pushing out a baby — I don't have kids, I've never gone through labour, but the whole idea makes everything tighten up, because you're thinking, "oh my god." So practising that relaxation before, when you're in that extreme circumstance — how can you just magically relax everything?

Cherry: Practising the relaxation well and truly beforehand. Even if you hear a big bang, everything tightens — so staying connected and teaching that is important. But also remember labour is a process, not something that happens suddenly. Even a fast labour generally takes time — the cervix has to shorten, thin out, open up. That's a big change and it takes time. There are changes to your pelvic floor throughout labour too. As you're pushing the baby, that pushing phase can take up to half an hour, 40 minutes, sometimes up to an hour. It's a process — and where there's a process and awareness of your pelvic floor, you can work with your breath, positioning, and a pushing technique you've learned preparing for labour, which helps facilitate it. We're designed to have babies vaginally, most of us.

Louise: So do you think pregnancy and childbirth are always responsible for pelvic floor problems?

Cherry: No. It's not always pregnancy and childbirth — it can be constipation, or worrying about things like public toilets. It's interesting the number of people we see with bladder or bowel issues who talk about their childhood — "I've always felt anxious about sitting on the toilet because I had an outdoor toilet and my little brother told me there was a snake in it," or the mum who always said "go, just in case." All of those things we're taught as kids can affect our bowel and bladder habits as adults. It's that whole adage of the body keeps the score — so many things along the way can contribute to pelvic floor dysfunction, whether it's trauma, incredibly painful periods, endometriosis, pelvic surgery, or life stress and anxiety.

Genia: Can I add to that? I think the design of the toilet seat is the culprit of constipation in the Western world, to tell you the truth. I often ask myself why constipation rates are much lower in Eastern countries, where they never talk about it. It can be affected by food, but ultimately they have squat toilets — and if you think about anatomically and physiologically how things work, sitting upright on the toilet is the worst position, because it doesn't relax you or get you into the right position for evacuation. That contributes to a lot of constipation in our Western world. It's one of the first things we talk to patients about — how do you sit on the toilet?

Louise: Well, also with public toilets — I remember asking a girlfriend if she puts paper around the toilet seat, and she said no, she squats — "it's good for my thigh muscles."

Cherry: You can't go back to pelvic floor like that. If you're hovering, your muscles aren't relaxing, so you're not going to empty effectively — you might not have a full evacuation. And if you push harder, that's increased pressure on the pelvic floor — you're working against yourself. It's like the analogy of trying to walk out of the room while you're closing the door.

Louise: I'm gonna make her listen to this and say I was right — hovering over the toilet is not it. I tell people to have disinfectant wipes in your bag and give it a wipe.

Cherry: The urine is actually quite sterile, for what it's worth.

Louise: On toilet posture, the other thing we often see is people with a higher toilet or shorter legs coming up onto their toes to lean forward.

Cherry: Our thinking is that your calf muscles are on the same neural supply level as your pelvic floor, so it's very difficult to relax your pelvic floor if you're up on your toes in a calf-raised position. Calves down, lean forward, wide legs to open the pelvic floor — and if you need extra support, a squatty-potty or small stool helps.

Louise: Do we need the poo stool if we're doing a wee?

Cherry: I always tell people to sit in the same position for a wee as for a poo. But most people, unless they've got poor hip flexibility or really short legs, can get into that position without a stool.

Louise: That's because you're quite tall.

Cherry: But you can still lean. With a bladder it's a bit different — generally you should be leaning forward, but once the bladder is empty, it's more of a passive component. With bowels there's an active pushing component; as long as you're in the right position, that optimises the pushing.

Louise: So we shouldn't be pushing at all when we wee?

Cherry: Absolutely not — even if you're in a hurry. You'll save ten seconds. It's not worth it.

Louise: But why is it bad to push out a wee?

Cherry: When you're pushing using your tummy muscles, it's activating your core and tightening your pelvic floor — so it's actually counterproductive. You're forcing it out against resistance, like turning a hose down to a strong jet instead of a relaxed, efficient flow. Stop and flop.

Louise: And Genia, how does menopause and aging affect the pelvic floor?

Genia: With menopause and aging we get hormonal changes that work on the muscles and connective tissues, affecting the support of the organs. Our muscles lose muscle fibres as a natural process, which can result in weakness — pelvic floor muscles are the same composition as any other skeletal muscle in the body. That's where you may encounter incontinence, prolapse, and so on. Someone might have had mild symptoms before menopause, and then, because of the big hormonal changes, the connective tissues become less elastic — without oestrogen, which gives us plumpness and elasticity, the tissues no longer recoil as easily. That can result in prolapse or urinary urgency, and the tissue becoming thinner can also increase sensitivity to urinary infections. There are obvious changes happening, but it's not all doom — it can be managed very well, providing you get the right information and the right treatment.

Louise: What about estrogen creams or the estrogen pessaries — will they help?

Genia: Absolutely. Recent studies show that for most people it's best to speak to your GP about suitability, because of individual medical history, but for most people these creams are quite safe — they're a very low concentration applied topically around the vagina and pelvic floor. A disclaimer, of course — if there's a history of cancer, or you're on medication like an estrogen receptor blocker for estrogen-driven breast cancer, using estrogen creams may not be suitable. You need to be informed with your doctor and go through the options. Pessaries come as a little tablet applied with an applicator — it's just a different formulation, and it's a matter of preference. Recent studies suggest that for many women, estrogen creams are easier to absorb. You do need a script for it, so you can't just go to the chemist.

Louise: That's unfortunate.

Genia: I think it's a good thing, really — but it's easy enough to see your GP.

Louise: And Cherry, at what age do you see changes through the pelvic floor?

Cherry: We can see pelvic floor dysfunction at any age, though menopausal-type changes — perimenopause — can happen up to ten years before menopause. Menopause is just a term for 12 months without periods, so it's not very well defined, but the average menopause age is 52, with some as early as their early forties. We might see changes present as genitourinary symptoms of menopause — dryness, irritation from tissue and pH changes, and an increase in urinary urgency or incontinence. So if someone's presenting at 45 and mentioning sex has suddenly become a bit more uncomfortable, we'll suggest they have a chat to their GP, even though it's perimenopause.

Louise: I didn't even know about the pH thing.

Cherry: It's like your vaginal microbiome — with a drop in oestrogen, everything becomes less acidic, so you can be more prone to UTIs, and recurrent UTIs can set off a pain process. It all keeps going around in a circle — bladder sensitivity and so on. It's about looking out for those patterns.

Louise: And Genia, can athletes and highly active people — dancers, gymnasts, runners — develop pelvic floor issues as well?

Genia: They can. I came across a statistic I found mind-boggling: 50 to 80% of high-level athletes can have pelvic floor dysfunction, which is quite high given you'd think these are the healthiest people. With high-level activity you're putting the body through above-average pressures and demands, and the system may have to overcompensate. We see a lot of younger girls who exercise a lot developing an overactivity in their pelvic floor muscles because of the increased demands of the core during jumps or running. It's not as uncommon as I thought — and the symptoms can include incontinence even with an overactive pelvic floor.

Louise: I saw an athlete on Instagram who was pregnant with twins, doing a shoulder press squat with massive weights. I was thinking, isn't that going to be bad for her pelvic floor? Or is it fine for her, but other people watching might think they can do the same?

Genia: There's no one-size-fits-all — it's very much about your baseline. If she's always been doing that, she's probably actually going lighter or not as deep than she was before — she might have modified it. But someone starting weightlifting for the first time while pregnant with twins, we'd say no, don't do that. It's very personal — you look at what the person wants to achieve, but also where they are, and whether it's functional or dysfunctional. I had a girl recently wanting to get back to F45 doing high-intensity classes, but every time she does, she gets terrible bladder pain. We look into why — is something tearing, bringing it on? She had an overactive pelvic floor and overactive abdominals. By modifying her technique — activating her pelvic floor appropriately rather than bracing and increasing abdominal pressure downwards during something like a box jump — it has a very different effect on her pelvic floor. It's quite personal, and that's where, coming back to Health Canvas, we look at the person individually and either strip off layers or layer on new ones based on what they need.

Louise: So Cherry, does chronic stress — if someone's really highly stressed — affect the pelvic floor?

Cherry: Yes, absolutely. If your nervous system's heightened, you tend to carry more muscle tension anyway. The pelvic floor muscles specifically — we call them the bouncers of the pelvis. You've got very precious organs in there — fertility, bladder, bowel — so if you've had a lot going on in that area, those muscles can tighten protectively. That can be part of it if you've had trauma, particularly sexual trauma. There's also that biological "tucking your tail between your legs" protective mechanism, which involves other muscles like the psoas too. If you're in that protective nervous-system mode, the pelvic floor is often a big part of tightening and trying to protect you.

Louise: That sounds exhausting — if your pelvic floor's on all the time.

Cherry: Yeah, and then it goes up the chain — pelvic floor, breathing mechanics, neck, shoulders, jaw. It's all connected. Interestingly, neonatally, when we develop in utero, the neural tube ends up being our gastrointestinal tract — our mouth and our other end develop from the same spot. So there's a neonatal connection there too, which we can use for people who have poor awareness of their pelvic floor — one trick is pursing your lips to see if you can feel your pelvic floor muscles more.

Louise: I didn't know about that one with the mouth and the pelvic floor. But the other thing — we hold tension in certain areas of our body without realising it. The pelvic floor is a hidden spot.

Cherry: Yes — you always notice when your neck's sore, but people say, "I don't know where my pelvic floor muscles are, how would I know?" Becoming aware is already a big step forward. It's a big thing with body image for women too — trying to hold everything in all the time, always pulling your tummy in. It's exhausting — and when your tummy's in, your pelvic floor's on as well.

Louise: A lot of Pilates instructors probably have tight pelvic floors because we're always pulling our tummies in — can't look like we've had too much dinner the night before.

Louise: So Genia, what happens to the pelvic floor during pregnancy?

Genia: We touched on the hormonal changes — physically, as the baby grows in the uterus, the centre of gravity changes and pressure load increases, and the pelvic floor accommodates for that. There's some lengthening of the pelvic floor, which is a natural process. Connective tissues becoming softer and looser can put more demand on the pelvic floor, which can become overactive in certain areas. Progesterone slows down our gut and makes our vessels a bit floppier, so women may be more prone to constipation with pregnancy, which affects the pelvic floor too. Most of these changes are a natural process — your body's amazing at accommodating the growth of the baby. The pelvis's ligaments soften to accommodate the baby coming through the birth canal at the end of nine months, and it takes time for the hormones to work on those ligaments. The pelvic floor musculature has to pick up the slack a bit, and it does, most of the time.

Louise: And Cherry, what should pregnant women do to protect their pelvic floor during pregnancy?

Cherry: Staying active and staying connected with your pelvic floor so you have good function of both contracting and relaxing throughout — because it changes each week, and that's quite a huge change. Looking after your bowels — being aware it's common to get constipated with hormonal changes, so have a good plan of action, starting simply with water and fibre, but sometimes needing extra help with a laxative if needed — you'd chat to your obstetrician about that. If you're finding you're heavy with muscular changes, wearing some compression can help — a simple tubular bandage around your tummy, or pregnancy compression shorts that lift the gusset and support the pelvic floor. Even something that helps lift the tummy a little can make a difference, because with the centre-of-gravity changes, your back muscles and pelvic floor can be working so much harder — that little bit of lift helps everything have a bit of a rest.

Louise: I've heard about undies that work almost like a bra, supporting the pelvic floor.

Cherry: There are a few different brands on the market — undies, and also compression shorts, in pregnancy and postnatal versions. You want to optimise movement and mobility too, because if women are having trouble with pelvic pain or back pain, or issues with the pelvic floor, not exercising or moving can affect constipation as well. It's all about keeping moving and active, and having the support can make the difference in whether you go for that walk or not.

Louise: So Genia, how soon should someone see a pelvic health physio after having a baby — or should they go before?

Genia: I get very excited when somebody comes in and says, "I want to get pregnant" — before you're even pregnant. It's so good, because then you can talk about habits and any little issues that can be managed, and introducing exercise before pregnancy is so much easier, because your body's familiar with movement. If you're already pregnant and want that information, even without issues, it's fantastic — it's much nicer to prevent things than to treat them. If you've had a poor first trimester with no energy, that's fine — as soon as you have energy and want to get back into exercise, come and see someone for the right advice. If you're having issues, see a pelvic floor physio straight away — don't wait for issues to get worse or assume they'll resolve themselves. Most of the time we're talking about things that are changeable, easily, and you see the result — it's not always a procedure, surgery, or medication. If you've had a great pregnancy and delivery with no issues, you can wait six weeks postnatally to see a physio, because by then you've got more of an idea of how things are with the baby and hopefully a bit more sleep and energy. But if there are problems before six weeks, address them immediately — little things you change early can have a big impact on how you feel.

Louise: And Cherry, what are the warning signs that you should book in to see a pelvic health physio postnatally?

Cherry: Changes in bladder sensations — even post-C-section. Noticing heaviness in the pelvic floor — it's not a panic situation, but things like recommending compression, adequate rest, and letting everything heal properly can really help. Constipation, and pain — pain is a big one, which can be helped early with compression, relaxation, and breathing exercises if your pelvic floor is "on" and causing pain. You don't have to wait until six weeks. And musculoskeletal issues — sore necks and backs — and mastitis, which can be so painful and can be helped early with ultrasound and advice.

Louise: I was thinking it's probably a good idea to see someone before you're even pregnant, because morning sickness and vomiting all the time would put a lot of pressure on the pelvic floor.

Genia: In extreme cases, yes. But I remind myself that pregnancy is a normal state — it's something we're designed to go through, and most of the time our bodies manage it well. It's when we introduce other things — like working until 36 weeks pregnant, eight or ten-hour working days without time to go to the toilet, things we and society impose on ourselves — plus maybe a toddler or two on top of working, that make pregnancies more difficult and challenging.

Louise: And Genia, is leaking after childbirth normal — a cough or sneeze and a little bit leaks out?

Genia: If you've just had a baby, it's not uncommon — it can happen — but it's not normal. Immediately after delivery there's quite a bit of stretching to recover from, possible swelling, and if it's a vaginal delivery, possibly a disruption to some fibres — a tear, or an episiotomy, or nerve compression. These can all result in temporary loss of bladder function, but again, it's not "normal" in the sense of something to just accept — it needs to be addressed. Reassurance is really important too — explaining those early changes, because in the throes of postnatal chaos it can feel like "this is my life forever." Explaining healing times, and that a long pushing stage causing nerve compression can take a bit longer to resolve, but it's not permanent, is important. Then giving strategies — looking after swelling, support garments, extra pads, good bladder habits — and reminding people of those things at the right time.

Louise: So Cherry, what is a pelvic floor friendly exercise?

Cherry: It's such a personalised thing. If you have someone with a very weak pelvic floor or prolapse symptoms, there are ways to mitigate load — the position of the exercise, for example: lying, side-lying, four-point kneeling, or supported sitting gives you less downward pressure from gravity than standing. The way you use weights matters too — a single bicep curl instead of a double is less pressure. And really importantly, how someone does an exercise — if they're lifting something, racing, and holding their breath, that puts a lot of load on the pelvic floor, whereas if they can breathe normally and draw up through the pelvic floor to match the load, that's pelvic floor friendly. Then there's the flip side — someone with a very tight pelvic floor and pelvic pain — we'd focus on not doing too many pulses or repeated exercises, more time to relax between reps, maybe more stretching in the program, and using the breath to help relax the pelvic floor. It comes down to what their pelvic floor is doing.

Louise: And Genia, what's an example of an unfriendly pelvic floor exercise?

Genia: It's very personal, depending on who's performing it and their pelvic floor's ability to match the demands. There's no specific exercise, but you have to ask: am I able to maintain good form while doing this? How am I feeling during, and how am I feeling after? Like that example of the young girl wanting to do unmodified F45, but having difficulty walking afterward because of bladder pain — that's very unfriendly for her, while the person next to her might be fine. It's personal, but you've got to listen to your body. Having a thorough assessment with a professional gives you insight into what can be modified so an exercise becomes friendly instead — you might still do the movement, just modified so it has less unfavourable impact on your pelvic floor.

Louise: I really love that I've been able to refer so many of my clients to you, because I have no idea what's going on with their pelvic floor — I'm not doing an examination. I believe all Pilates instructors should have someone to refer to, because we're quite often working with women's bodies through pregnancy, postnatal, perimenopause, menopause, and aging bodies.

Genia: It's also really great to see this collaboration, because there are things we do that you may not have the skill for, but there's so much you do, and you see your clients more often than we do — you have an incredible impact on your patients. I get really excited about this mutual collaboration, because this is how health and wellness should be.

Louise: It's made a difference to a lot of my clients just being able to see you — they're getting information they didn't even know about their own bodies, and it makes them feel reassured and more confident in themselves. That self-knowledge is so valuable.

Louise: So Genia, when should a Pilates instructor refer a client to a pelvic health physio?

Genia: As a Pilates instructor, you have a relationship with your client and a feel for when they're not managing certain positions in class, or when they make a comment that alerts you to a possible pelvic floor issue. When they've had a change in their wellness or medical management — a surgery, particularly in the abdominal, pelvic, or back region. If they mention problems with pain, bladder, bowel, or intercourse. And if you're seeing them not managing the exercises you're giving them — going to the toilet all the time, or tricking a lot when you give them modifications and they're still not able to do what you want — then perhaps they need a more thorough assessment to find out what's actually restricting them.

Louise: I was teaching a pre- and postnatal Pilates workshop in Canberra recently, and we discussed how you know when to refer. Someone said you just get a gut feeling — a sense that you can't give a client the help they need.

Cherry: You do work closely with people, especially in one-on-one sessions, so you get to know them really well.

Louise: And Cherry, what information helps create the best outcomes when health professionals work together?

Cherry: When you're sending someone to us, it's really helpful to have the background — their goals, what they want to achieve, and other medical things, like if they have osteoporosis and want to work on that but need to be careful of their pelvic floor. How they're responding in class is helpful too. And if it is a pelvic floor dysfunction, we can give you feedback on what the main dysfunction actually is — we get a lot of people who say "I've got a really weak pelvic floor" when they're actually tight, not weak at all. So having that understanding of the main goals for the pelvic floor during a class, and a clear guide, is really useful.

Louise: It's made me a better Pilates teacher, because now I know how I should be looking after people in class — what positions are better for their pelvic floor — and it gives me more confidence, because you don't know what someone else's pelvic floor is doing until you know.

Louise: And Genia, what does an ideal rehabilitation pathway look like when working with someone with pelvic floor issues?

Genia: Rehabilitation is a process, not something done in one session. We look at the goals — short-term and long-term — and the timeframe for reaching them, and the pathway: guidance from a clinician like myself or Cherry, perhaps seeing someone once every few weeks to monitor progress and progress their exercises, combined with someone like you seeing them three times a week doing a specific program. That helps achieve the goals in a faster, more timely manner — and not make them worse.

Louise: That's what I'm worried about — if I give someone an exercise that makes them worse. I want to be doing the right thing by them. I feel like my clients get the best value because they have that understanding of themselves, they get to see a specialist, and they're still coming to Pilates.

Genia: That's the optimal way, because what they do with you helps achieve their goals — compliance is better, and having a second person looking at them is reassuring. That communication between clinician and therapist really optimises the whole process.

Louise: I've had a lot of conversations with Cherry — she's almost like a mentor to me. I feel like I can ask her anything.

Cherry: For anyone's pelvic floor, incorporating daily or weekly exercise as part of their lifestyle is so important for pelvic floor health — providing a safe environment to exercise in, with good technique, keeps your pelvic floor ticking along.

Louise: How can people find out about Health Canvas? Genia, where would people find you?

Genia: We're in Caulfield, in the heart of South Caulfield, not far from Princes Park — 235 Bambra Road is our address. We have a website where you can look through our services and book online, or give us a call — our reception staff will answer your questions and find a suitable time. I think the website is probably the easiest — just Google us, Health Canvas, and book to see us. We work closely with local communities in Caulfield, Elsternwick, and St Kilda — some GP clinics and specialist clinics have our brochures, but generally, just Google it.

Louise: Thank you so much — it's been so wonderful, I've really loved it.

Cherry: It's been great, it's fun.

Louise: We didn't have to be so nervous after all — you're very easy to talk to.