Physical Therapy

Hopefully the only member of our family who will need diapers in the near future!

The super young, super fit receptionist hands me a clipboard and a questionnaire.  It seems normal enough... until you start reading the questions.

Page 1: Tell us all about peeing your pants.  I mean ALL about peeing your pants.
Page 2: How about sexual dysfunction?
Page 3: Poop problems.  You know you have them.  Spill it.

Grand!  Urinary incontinence, sexual dysfunction, and poopy problems!  The three things I most want to talk about with a stranger!

I came to pelvic floor physical therapy, not so much because I need it terribly badly, but because I'm irrationally terrified that my vagina is going to fall out of my body someday.  The midwife says, "Do your Kegels!" I wonder, am I doing them right? 

Urinary incontinence is common after vaginal delivery.  Often it gets better.  Sometimes it doesn't.  Even if you had all c-sections or never got pregnant to begin with you can end up leaking pee after menopause anyway because, lucky you, it's just in your genes. 

They had me do purple pushing in the hospital.  Ladies, listen to me, when those L&D nurses yell at you hold your breath and push as hard as you can to their count, the correct response is, "FUCK OFF!" 

I didn't know that at the time.  So for the first two or three weeks after I delivered Elsie, I leaked urine.  I leaked when I sneezed.  I tried not to laugh too hard.  The problem, part trauma and part hormones, fixed itself eventually.

Laurel's delivery was better.  Incidentally, the correct response to "Stop pushing!" is also "FUCK OFF!"  Ten minutes after delivery, I felt as though I never had a baby at all.  No leaking.

Lucia's birth was quite smooth.  My midwife instructed me productively.  You can delay pushing by blowing through soft lips (like a horse!) but when it's really go-time, your body will take over and push quite powerfully without you having to try to bear down at all.  It will be automatic.  This is the gentlest way to do it.  Still, Lucia is my third baby, the biggest yet.  Breastfeeding keeps everything in my body weird longer.  Two months out, I'm mostly back to normal, but I still feel urgency when I take a long walk.  I have to plot my walks around public restrooms.  "Why don't you try PT?" my midwife suggested.  "It's best to build strength in your pelvic floor now.  You'll need it when you're older."

So I answer all three pages of embarrassing personal questions.  I walk past all the injured athletes, into a quiet office with low lighting and a padded table.  I lie, balancing Lucia on my chest, and receive a whole new sex education from another fit and ponytailed woman who is surely too young to have any of these problems herself.

I learn that I have been doing my kegels correctly.  I learn that my muscle tone is good.  Maybe too good.  I learn that sex isn't supposed to hurt.  Not ever.  I learn why putting my feet up on yoga blocks is the only way I can comfortably have a bowel movement, and that I should probably be putting them up even higher.  It has to do with anatomy, not childbirth.  You should try it sometime.  Knees above hips.

Finally, I learn that my problem is likely the opposite of what I thought.  Not that my pelvic floor is too week, but that it is all seized up, triggering feelings of urgency by pressing on my bladder.  I'm not about to wet my pants, it just feels that way.  There is this whole different set of pelvic floor exercises that lengthens the muscles.  I need to stop doing Kegels for a while and figure out how to do these exercises instead.  I can't manage even one at my first visit. 

All week, I pay attention in the bathroom.  I pee without pushing.  I stand up, I sit down, I try again, as instructed, five times, every time.  By my next visit,I can finally do the lengthening exercise. 

It is a strange education, this PT.  I always thought I was very in touch with my body,  knowledgeable about my anatomy, tuned-in  Yet, when I lie there receiving a tiny pelvic floor massage from inside my vagina (REALLY WEIRD), I am not even sure how to answer the question, "Does this hurt?" 

No.  I mean, I don't think so.  It's uncomfortable.  Wait, maybe it does hurt!  How is this supposed to feel?  What are you pushing on?  Is that the same muscle as a second ago?

Empowerment and education be damned.  I know diddlysquat.

***


I wanted to share this experience because the issue of postpartum urinary incontinence is a really common one, yet it is generally kept very private, or shared in a way that is TERRIFYING to expectant moms.  Embarrassing postpartum annoyances are normal, and when the body does not manage to entirely heal itself, there are good solutions.  You just have to know who to talk to. 

Pelvic floor physical therapy exists!  It is here for both men and women.  For those who pee when we sneeze, for those who have pain during sex, for those who struggle with erectile dysfunction or difficulty achieving orgasm, and even for those with chronic constipation.

If you're starting online, I found these three resources helpful.  Real PT, though, is an in-person thing.  I don't think I would have discovered my problem without a knowledgeable person doing an exam and asking me those three pages of embarrassing questions.  Be healthy, and wish me luck at my next super strange pelvic floor therapy session! 

Pelvic Pain Rehab: Q&A including a question about pelvic floor drops

Be Fit Mom: wonderful explanation of Kegel exercises, as well as abdominal separation rehab

Squatty Potty: A product, but it has information, and you can achieve the same effect with any handy prop