The lost city and the pelvic floor

I recently watched “The Lost City.”  while I was recovering from covid and just wanted something lighthearted.  And this movie did not disappoint- it was just what I needed.  I so appreciate stars like Sandra Bullock, Brad Pitt, and Channing Tatum being silly and making fun of themselves.  So, if that is what you need, I strongly recommend this movie.  But I also see all things through my urogynecology lens.  This movie made four points about the pelvic floor. I’m pretty sure they didn’t mean to but they did.

So here are four points about the pelvic floor from the movie “The Lost City.”

Kegels are confusing.

There’s a scene where Sandra Bullock is strapped to a chair and they’re trying to fit her in the back seat of a teeny car- think smartcar size.  It is ridiculous but hilarious.  They can’t close the car door because her legs are sticking out.  So, the Channing Tatum character tells her to kegel.  Now while his character is beautiful but not brilliant, this is a perfect representation of what many of us know about kegels.

We know it is a contraction.  We associate it with women.  It tightens something in the pelvis.  But there is a lot of mystery and confusion there.   Now, please don’t misunderstand me.  I love the fact that they used the term kegel.  It isn’t something that you hear frequently in movies and I love that it is becoming more common.  If we can talk about it in jest, we can talk about it at other times.

But let’s just review a kegel and what it does.

A kegel contracts the pelvic floor muscles, also know as the levator ani.  If there is a finger in the vagina or anus and you perform this contraction well, you will feel the muscles squeeze in and up.  These muscles are connected to your anal and urethral sphincters so when you squeeze them, you can hold stool and urine.  If you are doing this correctly, you won’t squeeze your butt or your abs, just the internal muscles. Sometimes we tell women to do a kegel by imagining that they are sitting on a blueberry and trying to pick it up with the vagina.  And sometimes we tell women to try to stop their urine flow with a kegel (although it is not wise to do this routinely as it can confuse some of your natural reflexes).

But if you need to squeeze your legs into a car, a kegel won’t move your legs and help.  More about kegels here https://www.nafc.org/kegel-exercises?utm_source=Google&utm_medium=PPC&utm_campaign=Kegels&utm_content=Management&utm_source=google&utm_medium=cpc&utm_term=how%20to%20do%20a%20kegel&utm_content=421248201285&utm_campaign=&gclid=CjwKCAjwtcCVBhA0EiwAT1fY76RJjFS5zuaA8t3hBDnPP51qgcPzfJPJNNL_lEuKS0pbSQz4DuT2tRoCaKMQAvD_BwE)

We’d rather talk about the hooha.

There’s another scene where Sandra Bullock and Channing Tatum are trying to scale a mountain.  She is first but is too exhausted to keep climbing.  So, he keeps climbing, pretty much balances her on his head and lifts her to the top.  Again, ridiculous but hilarious.  And at some point during the climb, she says, “that’s my hooha.”   I hear the term “hooha” more often in my clinic than vagina.  Hooha, vajayjay, and “down-there’ are probably the most common terms I hear. But all kinds of words and terms are used.  My pocket book, my money-maker, and even my inside bits (which was partnered with my boyfriend’s wiggly bits).  We don’t talk about the vulva and vagina very much so when we do, we often aren’t sure what words to use.

It isn’t just the terms.

A survey from 2020 (https://www.intimina.com/blog/women-and-their-bodies/) found that 25% of women couldn’t identify the vagina on a diagram.  There are lots of reasons for this.  What we are taught in school.  Governmental regulations.  Fear that education will lead to an increase in sexual behavior.  But knowledge is power.  And we should all understand our bodies and how they work.  And be comfortable talking about how the body is currently working or acting up.

I am very used to the colorful way we describe the vagina and the embarrassment that comes with talking about it.  My advice  is that it doesn’t matter what words you use and how embarrassed you are.  If you’re having a problem, I want to hear about it.  If you don’t know what words to use, you can point and say something like “I’m having pain here.”  We can figure it out together.

My whole job focuses on the female pelvis and figuring out what is wrong.  I talk about these things all day long.  So much so that my family frequently asks me to refrain from using the word vagina at the dinner table (sometimes they need a break).  And the fact that this mainstream movie referenced the hooha made me love it more.  Because it just helps to normalize this part of the anatomy.  And this will lead to more conversation.

Take a deep breath in times of stress

There are several times in this movie when Sandra Bullock is clearly stressed and feeling like she can’t do something.  She’s panicked.  Maybe even losing it.  Has totally activated her flight or fight response.  And then she is reminded to take a deep breathe.  She takes a deep breathe, visibly calms down and is able to move on.  And conquer what she needs to.

Deep breathing or diaphragmatic breathing is a technique that we use all the time in pelvic floor health.

Diaphragmatic breathing can create a relaxation response, and it lowers your blood pressure and heart rate.  These physiologic changes can decrease anxiety.  It may seem hard to believe that breathing can do this when you breath all the time and don’t think about it.  But it is a powerful tool that you have always possessed.

Breathing is connected to the pelvic floor muscles.

When you inhale, the pelvic floor relaxes and when you exhale it contracts.  This is something that happens automatically unless you are having some pelvic floor dysfunction.  In that case, you often need to retrain your system with the help of a pelvic floor physical therapist.  This breathing technique is also something we teach in urge suppression, a technique to minimize urge incontinence.  I also advice women to exhale when they are doing an activity like lifting because it contracts the pelvic floor.  So never underestimate the power of a deep breathe.  What more information?  Check it out here (https://www.health.harvard.edu/mind-and-mood/relaxation-techniques-breath-control-helps-quell-errant-stress-response) And if it helps you, you can visualize Channing Tatum telling you to take a deep breathe.

Meditation is hard

In the movie, Brad Pitt is a master meditator.  He is shown to be cool in every situation.  Managing all kinds of chaos.  Oozing competence and reassurance.  But then he experiences some negativity and can’t get past it (I won’t give it away).  And moves from being the master of every situation to glaring with one eye open in meditation class.

Mindfulness is all the rage these days.

And meditation is one of the best ways to achieve mindfulness.  Mindfulness has been shown to decrease stress, anxiety, and depression.  It helps you focus on the present and not perseverate on the past or worry about the future.  It is a skill to help you manage stressful situations and face challenges with a new attitude and more patience and tolerance (learn more here https://www.mayoclinic.org/tests-procedures/meditation/in-depth/meditation/art-20045858) .

There are classes, and workshops and apps- all geared to help you connect with yourself and learn meditation.

These techniques can help with many health conditions including pelvic floor issues.  Meditation helps with anything made worse by stress.  And stress worsens many bladder issues and pelvic floor issues.  Being mindful can help you manage your symptoms in a constructive fashion and not perseverate or ignore them.  It can help you manage your feelings about your diagnosis and not become too overwhelmed or upset.  But while I intellectually know this, I find meditation to be so hard!   I completely relate to the Brad Pitt character because I’m the glaring guy when I meditate.  There is nothing easy about it.  Letting go of everything and being in the moment is challenging and requires daily practice.  But learning to manage feelings and responses to life with grace, patience and tolerance is often more than half the battle.

So, keep trying.  It will help in ways you can’t imagine.  Even if you do feel like the angry glaring guy when you are learning to let go.   So there you go.  This movie was all about the pelvic floor whether they realized it or not.  And just in case you were wondering, I did not mention the pelvic floor to my family while we were watching the movie.  Because they deserved to watch it from their own lens.  I may make them all read this post though, just to hear the groans and the “c’mon Mom, really?” that is sure to follow.  Living with a urogynecologist Mom may be exhausting.