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.
The Rounds
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.
In Motion
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.
Elevators
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!
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