Thriving Through True Healing: an Empowering Approach to Pelvic Health Care with Dr. Ashley Newton PT, DPT

As part of our Expert Spotlight Series, our founder Lauren chatted with Ashley Newton, a Doctor of Physical Therapy and a certified Pelvic Health practitioner with a passion for treating adult pelvic floor issues and yoga-related injuries. Based at Activcore in Princeton, NJ, Dr. Ashley combines her expertise in pelvic health and orthopedic physical therapy with her background as a certified yoga instructor. She takes a holistic approach to care, focusing on creating personalized treatment plans that reflect each patient's unique wellness goals. Dr. Ashley is dedicated to providing inclusive care, with a special interest in pelvic pain conditions and optimizing movement for yoga practitioners.

In their chat, Lauren and Dr. Ashley discuss the importance of pelvic health across various life stages, from adolescence to menopause. She emphasizes the need for education to empower individuals to understand and care for their pelvic floor, highlighting its 5 key functions and how the body adapts to pelvic floor changes. Dr. Ashley stresses that pelvic health care is about thriving, not just surviving, and encourages a holistic approach to healing that includes physical therapy, education, and support from other health practitioners. The ultimate reward of her work is helping clients feel empowered, confident, and fully in tune with their own bodies.

Check out 5 of our highlights below, or catch the full conversation on YouTube!

1. What to Expect at an Initial Pelvic Floor Physical Therapy Appointment

Lauren:

Will you tell us a little bit about what a typical day or week looks like for you?

Dr. Ashley:

I work clinically Monday through Thursday, and I see people one-on-one for an hour. So I see eight to nine people a day. I see people from the age of 16 all the way to the end of life. We all have pelvises, and at some point or another, there can be imbalances that need to be addressed and they can surface in different ways depending on what else is going on in your life and what your activity level is.

It's my job to be able to identify where the imbalance is in somebody's body and be able to provide people with tools as well as referrals to other healthcare practitioners that can help them along that journey of finding more balance in the brain and their body. That way, they can achieve their goals, move through life pain-free and uninhibited by any type of dysfunction in the nervous system as well as in the musculoskeletal system.

Typically, when I see someone for the first time, (it's also one-on-one for an hour) I will do a full movement screen. So that means looking at how someone walks, how someone squats, gets up from a chair, task-specific or performance-specific things. If I have somebody who dances, what type of dance do they do? I will have them demonstrate it. If I have somebody who plays a sport, we will even go outside and I'll see how they move with that just so I can do a comprehensive movement analysis and see where maybe things are devolving or could be tweaked a little bit. I really enjoy physics and I always tell people our body is a balance of vectors and forces throughout the body, and if something isn't working, ideally somewhere else will compensate.

Then I will do an abdominal evaluation. I will assess breathing, I will assess the movement of the tissues around the viscera, around the organs, and then I will do a pelvic floor assessment. I will either do a pelvic floor assessment rectally or vaginally, sometimes both. It depends on what someone is presenting with and the complaints that they bring to me.

And then I synthesize everything at the end and give people a comprehensive plan of where we're going, how long to expect in order to facilitate these changes so that from the get go, their brain and their body is oriented to a realistic expectation. One thing that I think our profession can get a little better at is explaining the process of strengthening, the process of relearning, the somatosensory experience, and the process of brain retraining so that people can have grace with themselves. There's nothing more frustrating than being two months into a program and someone's like, "I still feel like crap." And it's like, "Okay, but we had to pass these hurdles first." So I like to set people up from the beginning, because that's going to also change their progression and how they feel about their bodies and how they're moving.

Lauren:

I love hearing that, because I feel like I had pelvic organ prolapse after having my first baby, and it was a completely new thing for me. And the knowledge aspect of all of it is so critical. And I continued to have it after having my second, but I did not have the same experience. And it was because I had that awareness and knowledge of what this journey can look like and what my resources are and how long I can really expect things to take to recover and feel better. And to have the expectation from my provider that, "Hey, just because you get your symptoms down here doesn't mean they're always going to stay that way. You may have something happen that makes them spike up again, but then we can work to get them down." And so I really liked that part of the conversation because it can feel so discouraging when you're like, "Okay, I've got help. I'm doing all the things, and I still don't feel how I want to feel." And that can be really hard.

Dr. Ashley:

I'm very passionate about elevating health literacy and making people more knowledgeable about their bodies, especially people with female anatomy, because I don't feel that we get a comprehensive education about that as we move through the lifespan and hormones change.

I just want people to know more about their bodies, to be able to ask questions and not feel like they go into healthcare appointments like "deer in the headlights." Or that they saw something on Instagram, which can be so helpful, but can make us feel lesser-than, especially when things are sped up to two times speed, and we see these progressions of someone saying, "I started in August 2024 and here I am in December." And they may think, "Well, why am I not like that?" That "compare and despair" just tanks our nervous system, makes us feel bad, and can be so discouraging.

So yeah, I like to have that conversation from the start so people can be a little gentler with their bodies, but still challenge themselves. Gentle, but work hard.

 

 

2. The 5 “S”s of the Pelvic Floor

Lauren:

How do you explain the importance of pelvic floor health to somebody who either doesn't know anything about it or has maybe a very basic understanding?

Dr. Ashley:

So I think the best thing is metaphors and to use things that we commonly encounter in day-to-day life. I equate the pelvic floor to be like a house's foundation, like the skeleton of the house. With a very firm foundation, it's laid right. When they start to erect the building, you don't have any problems down the line. If the foundation is not set, the soil is uneven, there's sinking going on, everything above is going to be affected.

You can also say it's like the root of a tree. If you see that a tree has leaves that are turning yellow and falling off, we don't go to the tree and go, "Spray spray, you're better." We go, "Okay, what's going on with the soil? What's going on with the root system? What's feeding the trunk above?" So I started to talk about it in that frame of reference.

We also know that in yoga classically, the pelvic floor is looked at as the root, or the mula bandha. It is classically the perineum. And with chakras with yoga, it is the color red. So I like to think of it as the base. It is the place of birth as well as the place of digestion. And then I explain the five S's of the pelvic floor. Are you familiar with those?

Lauren:

I'm not.

Dr. Ashley:

They are:

1. Support: Support the organs above.
2. Sphincteric: So your mouth is a sphincter, your eyes are a sphincter. We have pelvic floor muscles that are sphincter, so they're responsible for closure and they're responsible for opening.
3. Sump pump: It's a major area of lymphatic movement. So lymphatic movement is metabolic waste that's produced by chemical reactions that come from you existing.
4. Stability: Stability of the bones. It provides stability to the sacrum.
5. Sexual functioning. So those are the five S's. It is a very quick and easy way to say, "This has a lot of functions." I'd have to review if it's 32 or 36, but I think there are 36 muscles attached to the pelvis. So there's a lot of stuff that goes there that if the base is a little imbalanced--maybe too much tension, not enough tension, too much tension at the wrong time--that can create dysfunction somewhere else.

"Dysfunction" can be a loaded word for people, so I just say it's anything that negatively affects your emotional and physical participation in life. It's not looked at as something bad. It's not pathoanatomical, meaning of the bones that something is wrong. It's just preventing you from living your best life. That's how I start the conversation.

Lauren:

I love that. I feel like it can feel out of reach for people if they don't know about it. So I think when you can talk about it in a way where it's like, "Oh, that makes sense to me." 

I also love what you're saying about the dysfunction piece, because you hear certain things and people are like, "Well, that's just kind of how it is." Or, "This is just what I have to live with now." And I like the piece about "relative to YOU what doesn't feel right", because I think it starts to shift the conversation for people to feel more empowered to seek help and make changes. Whereas otherwise, it might be like, "Oh, well, that's really not something I should be thinking about or working on right now."

Dr. Ashley:

And I always tell people, there might be something that's off, but maybe they don't have the brain space to work on it. Maybe there's too much going on. Maybe there's too much going on with a new baby, maybe too much with the partner, and they need to put their energy somewhere else. But that doesn't mean that working on that won't improve the other symptoms. It absolutely could. For example, if they work on the relationship with their body, with themself and they stop gripping their belly less, does that make it so that they can breathe better? Amazing. Then their pelvic floor is happier.

So I always want to look at those indirect correlates in the body, in the brain functioning, and how it affects the pelvis. It's very rare that I have someone with whom I do a full hour of corrective exercise. I tell people I'm not a trainer, that's why I hired one. My job is to help the body reformat patterns, and sometimes it does take the form of exercise, but often it takes the form of me doing hands-on work, changing this environment to change the inputs to the nervous system. So yeah, I think it's a lot more complex, but very individualized. It can be, at least I should say.

 

 

3. Healing vs. Surviving: Rethinking Pelvic Health Recovery

Lauren:

What do you see as some of the most common myths or misconceptions about pelvic health, or maybe the ones that kind of get under your skin the most?

Dr. Ashley:

I can only speak to where I live, which is in the United States, but unfortunately, healthcare here often becomes all about survival and survivorship. Like, "Oh, we got rid of your cancer, you're alive, amazing." "We delivered your baby, and both of you're alive and both of you are healthy enough, you're stable enough to go home."

But then we don't prioritize what it takes to thrive. And I don't even mean personal responsibility. I mean from a community perspective. I mean from family, from friends, from healthcare practitioners in your community. We kind of leave people to fend for their own devices when it comes to healing. And healing is different from surviving. A perfect example is when you give birth and you have a perineal tear. It happens, of course, and your body recovers from it. You go to your six week appointment and they say medically stable, and they're like, "Good luck with that." Not everyone says this, but oftentimes. And no tea, no shade. Doctors, physicians don't get a lot of time with patients unless it's usually concierge, for which you have to pay out of pocket.

And lay folks are not equipped to go in and say, "I have this question, this question, this question." That takes some coaching. "Okay, what if I try sex and it fricking sucks? What do I do? What about running? What about walking? What about just sleeping? Can I do anything for that? And what about eating? Do I need to eat a certain way while I'm breastfeeding? Is that going to help me?" There's no time in those appointments. So it's why I partner a lot with holistic health practitioners, acupuncturists, massage therapists, more concierge doctors, and then I educate the OB GYNs to help them think about a comprehensive plan. So I like people to have, especially with a surgery or postpartum recovery, a pre-op or prepartum plan, a peripartum plan, and a postpartum plan that includes all of those different modalities to optimize healing. And I'm very passionate about that. I feel like we could, in this country, do better at helping people thrive.

Lauren:

And I think that that's spot on because so much of it's narrowly focused. And I think as someone going through those things, you kind of feel like your OBGYN will take care of all of this. And at your checkpoints, these things will be addressed. And I think there's a misconception often of what they are really responsible for. And this wide community of people, with all of those different specialties you mentioned that can help all of those other areas thrive, can help it all come together.

So that's something I've experienced with friends and families, like, "Oh, well, I did my appointments, I went to the recovery appointments or whatever, and I'm still having these different issues." And it's like, well, they only address one piece of this and they have limited time to address it. And so I don't know what it will take to do the kind of things we're talking about where you can have this much more robust knowledge of what those options are. Because I think the first step is asking: who can help me with these things? And then how can I build them into a plan to support me and my family beginning and after these various things that you go through?

Dr. Ashley:

And normalizing that there's nothing wrong with you because you need help.

That is a big thing where people feel something is wrong with them because they need intervention, they need help. Really, the expectations should be set that this is a very normal, expected, and helpful part of the healing process.

Then if people feel that they approach it like, "Oh, I have to do this. Oh, something's wrong. My friend didn't have to do this. Why didn't she do it?"

And if I hear one more person say, "bounce back," I'm just going to lay on the floor. I'm just going to stop. I simply cannot. That term, I love language, and that term irks me in so many ways. Nothing is bouncing, babe. There is no bouncing. We are recovering, okay, we are putting work in. There is no one that bounces. The body does not do that. She heals. He heals. No, no, no. It's a very bizarre rhetoric that I honestly think just puts more pressure on people to come back and participate in making money and doing their paid jobs. And I'm just like, stop.

Lauren:

Well, and it completely ignores the transformative aspect that goes along with these things. It's meant to put you back where you were, and you're not there anymore, you were in a new place. So yeah, with the bouncing and the back--neither of those works.

Dr. Ashley:

Where are we going? No, we are moving forward. Language is powerful, and it sets expectations. And especially when we hear it from a person of authority, whether it be a mom, a dad, an older sibling, a gynecologist, a PT, anyone--it just makes you feel like, "Ooh, there's a problem with me." No, no, there's not. There's not.

 

4. Navigating Pelvic Health Across the Lifespan: How Care Evolves from Adolescence to Menopause

Lauren:

You've talked about seeing a wide range of people at life stages: early adolescents, pregnant, postpartum, and menopause. Will you just touch on, high level, how if someone's trying to understand how this can come into play across their lifespan, or maybe for people in their life who are at different life stages, how do people come to see you or how does this care evolve through my life stage, for example?

Dr. Ashley:

I would say in adolescence, maybe late adolescence, when menstruation starts, the treatment is about learning about your body. So it's a little bit of sex ed, it's anatomy ed. It's also getting comfortable with the dialogue about the body and being able to advocate in an educated way about what's going on, being able to articulate it in a way that makes sense to you and will make sense to the provider, number one.

Number two, being able to communicate with yourself and with your partner when they come along (and this is throughout the lifespan) about what feels good in your body. I do a lot of sexual health education and sex is a lot more than just penetrative sex. And that could be revelatory for a lot of people. And it takes at least one person to engage. One can engage with oneself, one can engage with another person.

I often tell my folks, it's like, we need to start changing how we talk about this, how we talk about our bodies. Because our brain remembers. If you remember you really hate wearing green, but you have to for work, and then you feel like shit later and I don't feel good in your body, are you really going to be able to be present for yourself and for your partner, if you have one?Probably not. Your brain's going to not be happy. So oftentimes I'm helping facilitate the exploration of expression, of authenticity, and exploring oneself. And it's throughout the lifespan, but I love it when I have someone who comes in early--good. Let's just do this now before you go into the world. That's a scary place.

As far as pregnancy and postpartum: when I have someone who is pregnant, I do a lot of education about the changes that happen hormonally within the cycle of pregnancy and what to expect in the body. And I actually set people up in the beginning with not only an exercise plan, but a plan for detection. Meaning, "Ooh, my hip feels a little off today. Oh, that's interesting. Was it in week 13? Oh, you're relaxed and it feels super high? Okay. What are we going to do to reset? This is my late first trimester plan." It looks a little different than my second trimester plan, in which I'm building stability, learning how to coordinate the pelvic floor in different directions. And then in the third trimester, it's more labor prep, getting fitted, believe it or not, for lymphatic garments, because a lot of swelling can happen during pregnancy, and people don't talk about that.

There's preeclampsia, and if that happens, that is medically intervened on. But a lot of people experience swelling and are just told to deal with it. But there's a lot of things that can make one comfortable and mitigate those symptoms.

And then postpartum, I go over a very rudimentary discussion about the importance of different amino acids and protein. I refer to an RD as it relates to wound healing and tissue regeneration, and then a ramp up plan with movement.

I also see a lot of people who have had cancer, and a lot of the cancer drugs will actually throw people into menopause immediately. And so I got a lot of clients who are bleeding, bleeding, bleeding, they get chemo, they're on tamoxifen. Maybe they have their uterus removed, and boom. Then the body's like, "Oh, crap, where's the hormones? What are we doing?" So I'll see these folks will come in with onset of urinary problems, and that's usually due to a tissue change. If they've had a mastectomy, the scars in the abdominal wall, in the chest wall, and those aren't being addressed. I'm very passionate about this. When it comes to cancer, it's very much "survive". And then the community in cancer is about "thrive."

And it's changing slowly, but pelvic health gets left out of it because when we think of breast cancer, we often don't think about the pelvis. But we know that the pelvic floor coordinates with the other trunk muscles. And so any insult above or below is going to affect the thing in the middle, which is the pelvic floor.

When it comes to menopause, perimenopause, menopause and beyond, I often coordinate with RDs, naturopaths, and gynecologists, because when people go through those hormonal changes, their body's ability to lay down tissue changes. So strengthening changes, your nutritional needs change in order to achieve those goals. That's why I have a dietician I refer to. And then the tissue changes at the pelvic floor because of the dip in estrogen. And that can also result in, oh, more UTIs because the vagina has become a more basic environment, letting bacteria thrive. People don't know that though. They're like, "I'm on azo forever." "I have UTIs all the time." And it's like, well, wait a minute. Are we using topical estrogen? Why not? And then with that, dispelling a lot of the belief that topical estrogen puts one at risk for breast cancer. No, no. That study in 2002 wreaked havoc on our healthcare system. The only thing that study did was increase women's mortality because they weren't going through hormone replacement therapy, because bone density changed, because they had more falls. Topical estrogen is not the same as HRT. For some people, it is not appropriate. If one has had ovarian cancer, I get it. But in the breast cancer world, it's in conversation now that it may be even protective, because it's not systemic estrogen. But oncologists and people don't want to get cancer again. And I get it. I totally get it. But I like people to have up-to-date information and know their options. If you don't want that, maybe we go from the hyaluronic acid. That's cool, that's fine. But we need to know. We need to know the most up-to-date information to make an educated decision about what's best for our bodies and involve and educate other healthcare professionals. I tell patients all the time, I'm like, "They aren't this Godlike person who can't learn. You can teach them something. They should be learning every day. Every day they should be learning."

5. The True Reward of Pelvic Health Care Is Self-Empowerment

Lauren:

Will you just share with us what you feel like the most rewarding aspect of your work is?

Dr. Ashley:

Yeah. The most rewarding aspect of my job is when people don't need me, and when they can show up for themselves. And that can mean anything. It can mean they show up at dance class. It can mean they talk to their partner. It can mean they wear the clothes that make them feel good. It's about people living for themselves, unabashedly and without shame.

I am very passionate about giving people the tools to feel their best emotionally as well as physically. So we always talk about it here. When someone comes in and they're glowy, they're just sparkly, and they're just happy. They're effervescent. They're not bogged down with the pain. They're not bogged down with past trauma that they have healed and gone through hard things to a point where they can get up in the morning and they're happy to get up in the morning. I could name very specific things that I'm very proud of all my clients for even just coming here. But I think that's the best thing is feeling empowered and showing up for yourself. And also not giving a fuck about what anybody says about you, your body, and just feeling comfortable in that.

 

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**Medical Disclaimer: This post is intended to provide information and resources only. This post or any of the information contained within should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your qualified healthcare provider with any questions you may have regarding your healthcare, conditions, and recommended treatment.