Warning to whatever male readers I may have:  

This is going to be one of those lady parts posts.  Before you read any further, just know that you have been warned!!!

I hesitated to write this post out of an instinctive embarrassment, but several girlfriends have encouraged me to write it.  They told me things like:

“You HAVE TO write this, Catherine!”

“EVERY woman needs to know about this!”

I’ve never shied away from sharing what I’m going through (miscarriage, postpartum depression, breastfeeding woes, etc.)  So, why should it be any different with this health issue?

Part of me had resigned myself to thinking, “Welp, this must be the new normal for my body that has borne these babes.  I better start getting used to it.”  The other, more optimistic part of me thought, “No way, José!  I’m not ready to resign myself to a life of wearing Depends at 30!  I’m going to explore every last medical intervention short of surgery before I throw in the towel!”

I decided to get brave and take the issue to my new OBGYN a few months ago.

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At my last annual gynecological exam, I said that my chief complaints were pain and discomfort associated with going to the bathroom.  After performing an examination, the OBGYN wasn’t very impressed, said I need to keep living with it if I want to have more kids, that he’d do surgery “once you’re done,” and that I should go on the pill to avoid getting pregnant and, therefore, worsen my condition.  After telling him for the 5th time in 5 minutes that going on the pill wasn’t an option for me, he sighed and said that physical therapy for pelvic floor strengthening might make my pain manageable.

It turns out there are very, very few physical therapists properly trained in pelvic floor strengthening.  (After you read on, perhaps you’ll understand why!  It’s quite the, uh, intimate experience.)  With a prescription for pelvic floor strengthening from my OBGYN, I made an appointment with a highly recommended physical therapist named Amy.  I was a tad nervous, especially since a new friend at Bunco who is also a physical therapist told me what I was in for.  Her description involved vaginal weights (yes, you read that correctly), electrodes being applied that would show me the strength of certain muscles, and some pretty, uh, vulnerable exercises.  After the frightening description of what I’d be doing at physical therapy, I honestly didn’t care.  When you’re desperate, you’re willing to do things like sign up for a session with vaginal weights!

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The day arrived for my first physical therapy session.  Amy escorted me back to the exam room.  It looked like a typical OBGYN’s office with chairs and an exam table (just without the stirrups).  First, I sat in one of the consult chairs while Amy asked me about my medical history and attentively took notes.  We discussed my pregnancies and deliveries.  After hearing that my 5’3″ frame delivered 3 relatively large babies (8 lbs. 7.5 oz., 8 lbs. 13 oz., and 8 lbs. 7 oz.) and had a miscarriage within the span of five years, she raised her eyebrows.  “Woah.  We say that the pelvic floor sustains trauma when a woman has a baby 8 pounds or larger.  Your poor pelvic floor has had a lot of trauma!”

I talked about the chronic constipation I’ve battled since my first pregnancy.  My morning sickness that usually lasts up until about 24 weeks leads me to depend on the anti-nausea medicine Zofran.  I have a love/hate relationship with Zofran.  While it makes the nausea manageable, it makes the constipation worse.  My first delivery was difficult and nearly resulted in an emergency c-section.  Fortunately, Jane’s heart rate came back to where it needed to be, and she was delivered–after two days of active labor, 3 hours of pushing, an episiotomy & major tear, and forceps.  Youch.  With each subsequent pregnancy, the constipation, hemorrhoids (thank you, 3 hours of pushing!), and perineal pain got worse.

To add insult to injury, I struggle with urinary incontinence.  With every laugh, sneeze, cough, or slight jump, I pee a little.  If I want to put on my Jillian Michaels 30 Day Shred DVD, I have to put on a heavy duty overnight pad, go to the bathroom immediately before starting, begin the DVD, and take a bathroom break five minutes in if I want to stay dry.  Beautiful.  True story: There have been several occasions when I have been pushing a full grocery cart out into the parking lot and have to sneeze.  I can only imagine what I look like as I urgently scan the parking lot to make sure no one is going to hit me as I stop pushing the cart, cross my legs, and sneeze.  Perhaps that should have been a good signal for me to get some help!

With each pregnancy, my abdominal muscles continue to separate (a condition called diastasis recti).  When I am farthest along during pregnancy, it is not unusual for me to be able to put 5 fingers between the muscles.  This, combined with my weak back muscles, led to some bad sciatica (major pain on the sciatic nerve that radiates down from my back to my legs).

Finally, and perhaps most disheartening of all, I recently developed significant pain and discomfort every time I use the restroom.  I suspected I was experiencing a prolapse of my bladder, colon, and perhaps even my uterus through my vaginal opening.  In addition to interfering with my ability to have a normal bathroom routine, it was interfering with my martial life.  As you can imagine, I was in significant pain and discomfort.  I wanted to make sure this wasn’t a significant enough problem to need surgery before trying attempting a future pregnancy.

Amy took out a very helpful model of the female pelvis.  She pointed out all of the major players that make up the pelvic floor and explained what was happening to my body.  In a nutshell, my poor pelvic floor was giving out from all of its hard work.

After Amy showed me the pelvic floor model, she explained that she was going to do a basic examination of my body symmetry.  First, Amy had me stand with my arms at my side and then touch my hands to my toes.  She noticed some asymmetry that she anticipated because of my symptoms with my pelvic floor.  She walked me through a series of movements with me laying on the table that confirmed that my pelvis was tilted forward from the left.

Then, she explained that she wanted to perform an internal pelvic exam.  She wanted to perform the exam to find out where I was experiencing pain/discomfort, find out how much scar tissue I had, and see exactly what was prolapsing.  I felt like I was at my OBGYN office while I removed my clothes from the waist down and waited for her to return on the table with a sheet.

I learned a lot from the internal examination.  Amy pointed out during the exam where my scar tissue was and how severe it was.  Then, she had me bear down during the exam so that she could identify the prolapse.  As it turned out, both my bladder and colon were prolapsing through my vaginal opening.  Lovely.  No wonder I was in so much pain & discomfort!  She had me perform a series of different kinds of Kegel exercises to show her my baseline for both my slow and fast twitch muscle fibers.  They were WEAK!  Mary taught me proper technique for Kegel exercises so that I knew I was isolating the correct muscles to target my slow and fast twitch muscle fibers.

After the internal exam, Amy left the room so that I could change back into my clothes to learn some exercises.  I learned exercises to strengthen my abdominal muscles and close the gap from the diastasis recti.  Then, I learned exercises to realign my pelvis from its tilted position.  These exercises combined with the Kegels left me with a lot to work on.  In addition to the exercises, Amy asked me to keep a voiding log.  In the voiding log, I was supposed to record for 3 days what time/amount of liquid I drank (in approximate ounces), how much I urinated in approximate ounces (calculated by number of seconds it took for me to void), any amount of leakage I experienced (S, M, L), if the urge to pee was present, and what activity I was doing (if any) with the leakage.

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All of that was in just one appointment!  Since then, I have been working on my exercises.  I can already tell a significant difference in my pelvic floor strength, and my level of pain has diminished.  I had my second appointment yesterday.  We went through all of the same exercises to make sure I was still using proper form.

Then, Amy explained that we would be doing something called biofeedback.  Amy instructed me to remove my clothes from the waist down and put on a sheet before she left the room.  When she came back, she said that she would be applying various electrodes to the sides of my anal opening, and the third was placed internally.  The electrodes were hooked up to her computer that would monitor my muscle activity.  She turned the computer monitor toward me so that I could watch the screen with her.  It was like an EKG monitor that showed the slightest increase or decrease in muscle activity across a graph.  Amy instantly pointed out that my pelvic muscles were irritated and inflamed.  They should have been at a low level while resting, but they were significantly above what she would consider baseline in a typical patient.  Then, Amy asked me to perform a series of Kegel exercises that worked my slow and fast twitch muscles.  As I performed the exercises, we watched the screen’s graph go up and down.  It was gratifying to watch my strength and efficiency increase as we worked through the exercises.  Eventually, my muscles petered out, but not before I felt I was doing them correctly.

After two sessions of pelvic floor physical therapy, I have a few thoughts:

1. Pelvic floor physical therapy should be a routine part of a woman’s health care–especially after childbirth, while battling constipation/hemorrhoids, or during menopause.  After a few sessions with a trained physical therapist who can tell a woman she is doing the exercises properly, they should become part of her basic exercise regimen.
2. OBGYN offices should consider having an in-house pelvic floor physical therapist.  I can’t imagine a more natural “marriage” in healthcare.
3. Do not give in to the mentality that peeing your pants every time you sneeze has to be your new normal!
4. The Kegels aren’t just for you.  That’s all I have to say about that.  (You’re welcome, husbands.)
5. Every woman should know these basic pelvic floor exercises.
6. It is so empowering to regain control of my body and know that there are things I can do to get myself back in fighting form.

We haven’t used the vaginal weights I was warned about yet.  Maybe that’s for the third appointment.  At this point, I say bring ’em on!  This is a no-shame zone.  I’m gonna have a strong pelvic floor, gosh darn it, and I want you to have one, too!

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Questions for you:

1. Have you struggled with a weak pelvic floor?  Are my symptoms ringing a bell?
2. Have you ever sought help?  If not, what’s holding you back?