Inside the Box

In this episode, we sit down with Dr Gehan Karunaratne, whose specialist interest lies in plastic surgery, to talk about what actually happens when women decide on surgical repair for diastasis recti. 

Gehan brings something rare to this conversation: a physio background alongside his surgical training, which means he sees the abdominal wall from both sides of the journey. We dig into the gap between what women think they should fix and what actually needs fixing, what’s considered “normal” and why this isn’t as straightforward as it seems and the ins and out of surgical repair including the procedure itself and recovery timeframes.

This episode is for anyone considering surgery, for women questioning what’s normal and for clinicians wondering when it’s worthwhile to refer. 

Key takeaways

•A wide linea alba isn't automatically a problem, and a narrow one isn't automatically fixed. What matters is function, tissue quality and whether it's affecting your life.

•Prehab matters, but it matters more for some women than others. There's a point where conservation stops working, and surgeons may be able to fill that gap.

•Recovery is not linear, and it is extensive. This is not an overnight procedure. 

•The body image piece is as important as the surgical piece, and asking the right questions before surgery can save everyone heartbreak afterward.

•Australia's approach to diastasis sits somewhere between being evidence-informed and being shaped by what Medicare will fund.

We hope you enjoy this outside the “box” chat! 

Links and resources

•Dr Gehan Karunaratne: @drgehankarunaratne

This episode Caitlin puts Kat in the hot seat for an honest conversation about everything that’s been happening behind the scenes. From leading a growing business and raising a young family to navigating a recent ADHD diagnosis and building Hello Florense — a new bladder and bowel diary platform designed to improve efficiency and clinical decision making in pelvic health — Kat shares what’s been filling her days (and often her nights).

Together, they talk about the realities of leadership, why it can feel surprisingly lonely at times, the pressure of trying to do it all, and what happens when you stop chasing perfection and start embracing “good enough.”

It’s a relaxed, honest chat between two cohosts and friends.  

What we cover:

• What life really looks like behind the scenes when it can appear like you have it all together
• Balancing business ownership, family life, and ambitious projects
• Receiving an adult ADHD diagnosis and what it has changed
• The loneliness of leadership
• Building a new software and taking a leap of faith - what is Hello Florense and why it’s needed in pelvic health
• Learning to let go of unrealistic expectations

⸻

Connect or follow Kat at one of her many businesses!

@ivoryrose_physiotherapy

@helloflorense

@pelvicfloorfoundationsproject

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Inside the Box is hosted by Kat, Tash & Caitlin, where we explore pelvic health, healthcare, business, leadership, and the people shaping our profession.

In this episode we sit down with renowned physio Dr Carrie Pagliano to talk about one of the topics we get asked about most: running, lifting and exercise when you have a diagnosed prolapse.

Carrie brings decades of clinical expertise to a conversation that goes well beyond “just do your pelvic floor exercises.” We talk about the very real fear so many people feel around returning to activity after a prolapse diagnosis, and why that fear is so often bigger than the anatomy actually warrants.

We dig into what it looks like to piece the picture together for an individual, looking at the whole body and the many factors that contribute to symptoms rather than fixating on the prolapse alone. Carrie also unpacks the disconnect that can exist between symptoms and anatomy, why what you feel doesn’t always match what’s happening structurally, and how to manage that gap with your patients (or yourself) without it derailing progress.

We cover a practical framework for graded exposure to activity when someone is symptomatic, how to build back load and intensity without triggering a flare, and where internal pelvic floor devices fit into the picture. What’s actually out there, and what’s genuinely useful versus what’s just noise.

And we finish on the theme running through the whole episode: saying yes to running, weight lifting and the activities people love, because a person is not just a pelvic floor.

Whether you’re a clinician working with this population or someone navigating your own prolapse journey, this one will change how you think about “return to activity.”

Where to find Carrie: @carriepagliano
Listen to her podcast: ActiveMum Podcast

In this episode Tash and Kat chat with pelvic health physio Amelia Godfrey, founder of Pelvy, now supporting over 4,200 patients across 106 clinics in 6 countries.

Amelia shares how a gap she saw in clinical practice sparked the idea for Pelvy, what it took to build an app with zero tech background, and why she wishes she’d launched something smaller first.

We dig into the mindset of building a business from scratch, the hardest and most rewarding parts of entrepreneurship, and what kept her going through the uncertainty.

She also busts the myth that you need a huge following to launch something, breaking down what actually worked for Pelvy’s low-budget marketing, and why FOMO beats follower count.

We close on what’s next for Pelvy and where she sees pelvic health tech heading.

Connect with Amelia: @pelvy.app

In this episode of Inside the Box, we sit down with physiotherapist, business owner, mentor and mum Winnie Wu to explore the journey behind building not one, but two thriving clinics, while helping other allied health professionals create businesses they genuinely love.

Winnie shares how her background as a dancer shaped the way she understands movement, why she found her passion in pelvic health, and the experiences that led her to establish both Movement Lab and Papaya. We unpack the challenges of launching a multidisciplinary clinic during early motherhood, the realities of balancing business with family life, and how her own postpartum experience continues to influence the way she leads.

We also dive into The Clinic Project, where Winnie mentors clinic owners across Australia, discussing the biggest mistakes she sees, what effective mentorship really looks like, and the transformations that make it all worthwhile.

Finally, we explore one of the biggest conversations in healthcare right now: AI and innovation. Winnie shares practical ways clinics can use technology to improve efficiency and client care, along with her thoughts on where allied health is heading in the years to come.

Whether you're a physiotherapist, healthcare professional, clinic owner, or simply curious about the intersection of healthcare, entrepreneurship and innovation, this episode is packed with practical insights and honest reflections.

If you enjoyed this episode, don't forget to subscribe, leave a review, and share it with a colleague or friend who would benefit from the conversation.

Paediatric pelvic health is so much more than wees, poos and toilet charts.

In this episode, Caitlin sits down for the second time with Quiara Smith, a paediatric pelvic health occupational therapist, to unpack the layered world of toileting, constipation, stool withholding, sensory processing and teen pelvic pain.

Quiara shares why the 24–30 month window tends to be a more developmentally and physiologically supportive time for toilet learning, and why rushing the process can contribute to the rise in toddlers presenting with withholding, toileting refusal and anxiety that she is seeing in clinic.

They explore how toileting is a whole-child skill — one that draws on sensory processing, nervous system regulation, interoception, environment, confidence and readiness — and why a toilet chart alone often isn't enough.

The conversation also turns to teen pelvic pain, particularly in high-achieving adolescent girls presenting with tampon pain, constipation, bladder holding at school and difficulty down-regulating their nervous system. Quiara explains how she approaches assessment with teens without internal examination, using education, consent-based external assessment, SEMG biofeedback and functional strategies.

Quiara also shares the thinking behind her sensory screening checklist for clinicians working with children with toileting difficulties, and gives an early glimpse into her use of red light and blue light therapy as an adjunct in paediatric pelvic health.

In this episode:

• Why many children are not ready for toilet learning before 24 months
• Stool withholding, constipation and toileting refusal in toddlers
• The role of sensory processing and interoception in continence
• Teen pelvic pain, tampon pain and school-based bladder and bowel habits
• Consent-based assessment in paediatric pelvic health
• Biofeedback with children and teens
• Setting realistic expectations with families
• Emerging use of red light therapy in paediatric pelvic health

Bedwetting is one of the most common concerns families bring to a paediatric health appointment - and one of the most misunderstood. In this episode, Kat and Caitlin sit down with Dawn Sandalcidi, paediatric pelvic health physiotherapist, to dig into the evidence behind nocturnal enuresis: what’s driving it, how to assess it properly, and what actually works. Whether you’re a clinician seeing kids in your practice or a parent who’s been lifting a half-asleep child to the toilet at midnight for the past two years, this one’s for you.

In this episode we cover:

• How common is bedwetting, and when does it stop being “normal”?
• What’s actually causing it?
• How do you assess a child with bedwetting?
• Where does physio fit in?
• What does evidence-based treatment actually look like?
• Bedwetting alarms: the what, when, and how long
• Desmopressin: when does medication fit in?
• Should parents be lifting their child overnight?
• The myths and mistakes Dawn sees most often
  From fluid restriction to punishment-adjacent responses to starting treatment before a child is ready, Dawn shares the patterns she encounters regularly and what she wishes families (and clinicians) understood earlier. This section alone is worth sharing with every parent who walks through your door with a bedwetting history.
  
  Resources mentioned:
  • ERIC (Education and Resources for Improving Childhood Continence) — eric.org.uk
  • Bladder and Bowel Australia — bladderbowel.gov.au
  • International Children’s Continence Society (ICCS) guidelines on nocturnal enuresis
  
  About Dawn Sandalcidi @kidsbowelbladder
  Dawn is a paediatric pelvic health physiotherapist and a trailblazer and leading expert in the field of pediatric pelvic floor disorders. She is a national and international speaker in the field, and she has learned so much from sharing experiences with her colleagues around the globe.

One of the most influential figures in Australian pelvic health physiotherapy joins us this week. Taryn has spent decades shaping how clinicians learn and practice women’s health - and this conversation gets into the heart of how that happened. Personal, honest, and worth every minute.

What We Cover

• The early years. The experiences and influences that formed Taryn, and what the field looked like when she was coming up.
• Going straight into women’s health - Why she took a less conventional path as a new grad, and what was driving those early decisions.
• Finding her niche and founding WHTA - The turning point where women’s health became her thing, and how that led to building Women’s Health Training Associates.
• Growth beyond expectation - When she realised WHTA had become something far bigger than she’d planned, and what made that possible.
• Visibility and pressure - What it’s actually like to operate at that level of influence, and what’s been hardest.
• What people get wrong about success - The factors that have genuinely mattered across her career, and what gets oversimplified from the outside.
• The question no one asks - As a woman, mother, and leader, something Taryn is well placed to say but rarely gets asked.

You can find Taryn at @whtaeducation

Welcome back, and what a way to kick off Season 4! 

Taryn Hallam first joined us back in 2022 to talk birth choices, an episode that went on to become our most downloaded of all time. Now she’s back to open Season 4, bringing the research on a topic that deserves far more clinical airtime than it gets: vaginal laxity.

It’s a condition that affects more women than most clinicians realise, and yet it remains under-asked, under-assessed, and under-discussed in clinical practice. Taryn has done the work of pulling together what the evidence actually says and making it accessible for clinicians who want to do better by their patients.

In this episode we cover:
•What vaginal laxity actually is, why it happens, and how common it really is in clinical populations

•The distinction between somatic and psychogenic sexual disorders and why it matters for how we assess and communicate with patients

•The relationship between vaginal laxity and pelvic floor changes, including levator hiatal size and levator ani avulsion

•The important nuance in the data: 98% of women with vaginal laxity had a vaginal birth, yet 89% of vaginally parous women had no laxity at all. So what does that actually mean when a patient asks whether her birth caused this?

•Why the direct correlation between levator hiatal area and laxity sits at just ~23%, and what that tells us about the limits of a purely structural model

•Vaginal laxity as a symptom, something experienced rather than objectively measured, and how that should reshape clinical conversations

•The role of sensory signalling and processing, both peripherally and centrally, in how laxity is experienced

•Why lubrication matters, and the interesting finding that laxity appears more prevalent in pre-menopausal women

•Why PFMT seems to help, even though the research tells us it can’t reduce a distended levator 

•Neuromodulation and TTNS: could the mechanism be normalising sensory processing through sacral nerve roots rather than producing structural change?

Whether you’re a clinician or a woman who has experienced symptoms of vaginal laxity yourself, or you’re simply curious about the topic, you’ll find plenty here that’s relevant.
Subscribe, leave us a review, and share this episode with a colleague who needs it in their ears.

We’re closing out 2025 and wrapping up Season 4 with one of our favourite formats – the “Can I Say This Out Loud?” episode, inspired by the iconic Dolly Doctor. This is the space where nothing is too awkward, too specific or too “Is it just me?” to bring into the light.

In this finale, we dive into the real questions sent in by our Inside the Box community, covering everything from pelvic health curiosities to the myths that just won’t quit.

Here’s a snippet of what we unpack:
 • Vaginal trainers and vaginal weights – gimmick or genuinely useful? We break down where the science stands, who they may help, and when they’re not the answer.
 • Peeing in the shower – harmless, helpful or something to rethink? We explore the physiology, the myths and what matters most for bladder health.
 • Preparing for birth – both caesarean and vaginal. From pelvic floor considerations to practical planning, we talk through what to focus on, what to let go of and what supports women best as they approach birth in all its forms.

As always, we bring evidence, experience and a healthy dose of honesty to the questions many people are thinking but rarely ask out loud.

Thanks for being with us for another season. Your curiosity, conversations and courage to ask the “slightly awkward but deeply important” questions are what make this community what it is. We’ll see you in the new year for Season 4.