I am one session away from completing my pelvic floor physical therapy, or as I like to put it, one final exam away from graduating from “stop peeing myself” school. I've already written about my experience discovering that Kegel exercises were worsening my hypertonic pelvic floor during my pregnancy and my road to recovery. I want to follow up with some specific tips and exercises that I learned through my months of physical therapy.
Disclaimer: I am not a doctor, medical professional, nor expert on the pelvic floor. I am simply a patient who wants to share what I've learned. This advice is free, so you get what you pay for. If you want to learn more, visit your doctor or a specialist.
Also, if you're squeamish about female anatomy, you may want to avoid reading on.
There's a Floor to my Pelvis?
When I first started physical therapy, I didn't know what my pelvic floor was. I had practiced Kegels and knew how to contract the muscle that allowed me to hold in my pee, but that was the problem. I was hypertonic, so I knew how to hold it but not how to release it. As embarrassing as it is to admit, I wasn't aware of that muscle in my body.
Above all else, physical therapy allowed me to learn that this muscle exists and that I can control it. This was useful not only for holding in my urine, but also for childbirth prep and sex. Most of my postnatal care focused on toning the weakened muscle after vaginal birth.
Big Belly Blows
Among the first exercises I learned was called the big belly blow. We've all been taught to inflate our stomachs when we breath in and deflate when we breath out. Instead, with a big belly blow, we keep our stomachs inflated when we exhale. This releases the pelvic floor muscle and allows it to widen more easily.
In the chaos of the end of labor, when the nurses coached me to hold my breath and push, I ignored them. Instead, I did a series of big belly blows to open my pelvic floor. I didn't feel a ring of fire and my baby was out in three pushes. And I barely tore.
We all have moments of weakness. For me, it's my sneezing fits first thing in the morning before I've had a chance to pee. When we're most vulnerable is when we need our skills the most.
The rounds consist of four steps that I do at the start of every physical therapist appointment: 1) Squeeze tightly and release. 2) Cough and release. 3) Squeeze tightly, cough while holding, and release. 4) A small push. Not to get uncomfortably graphic, but the doctor first observes me doing the rounds with eyes only, then she feels my strength and range doing the rounds with her finger inside of me. My progress going through the rounds allows the doctor to assess how far I've come and what I still need to work on.
Coughing, laughing, and especially sneezing were killer for me. My husband used to jokingly ask me every time I sneezed whether I had peed myself. He no longer asks because I no longer do.
Most of the physical therapy exercises I learned consisted of contracting, holding, and releasing the pelvic floor while in motion: legs opening and closing, one leg lifted and lowered, squatting and standing, and even moving with a yoga/exercise ball between me and a wall. There was a time when I would pee myself squatting down to pick up something from the floor. Not anymore.
The most useful physical therapy technique for me for me was mental. I was to imagine that my vagina was picking up something small like a bean or ping-pong ball. Still imaginarily grasping it, I pulled it up through a series of levels until I reached the top of my pelvic floor elevator. Then I'd bring it back down. Pick up, to level one, up to level two, really strain to get all the way to the top at level three, then back down again, stopping at each level before finally letting the ball go. There was no real ball, of course, nor are there discrete levels in my pelvic floor. Eventually I got to the point where I could bring my pelvic floor from rest to top and back down in two flowing motions.
The Final Exam: Endurance
My last challenge requires stamina. I am to tighten my pelvic floor and bring it to a maximum, hold it for ten seconds, then release. When I can that, I'm to try for 20 seconds. One would think that this would be easy because I routinely hold my pee in for longer than 20 seconds. However, when we hold in pee, we're not at maximum. Bring my pelvic floor all the way to the “top of the elevator” and staying there takes tremendous focus and a good deal of strength. Hopefully, the next time I'm in my physical therapists' office, I can do it.
If you are a mother or mother-to-be suffering from urinary incontinence, I highly recommend seeing a pelvic floor specialist! Not only am I essential back to my pre-pregnancy normal, I no longer experience pain during sexual intercourse, which still amazes me. You carried and birthed or are about to birth a baby. Take care of your fabulous body!