You deserve to feel fine about your pelvic floor

"Everyone should be able to hold their pee! And their poop!"

In my work as a freelance writer, I recently finished a project related to women’s health that re-affirmed that society/the medical establishment’s approach to women’s sexual health can be summed up with:

and of course

So this email I got from a reader that was pre-emptively like “Do not wait to take care of yourself! You deserve to feel unbroken, at least in your pelvis, after having kids!” spoke to me. Here’s what she wrote:

Stress incontinence is not an inevitable stuck-with-for-life side effect of childbirth! And it is never too late to do something about it! My midwives (I’m in the UK) were adamant about this with both my kids. I have no issues at all 4 months after my 2nd. A runner friend who, two kids in, had incontinence and prolapse *and she is running again* with no worries. This after her physician said she’d always be leaky.

I’m not peddling any particular program or person (although I used Julie Baird’s on-demand program called ‘Mommy Body Bliss’ for those wondering. Bonus witch points for the fact that ‘a broomstick’ is usually on the equipment list.) But I think it’s important that people know they can hope for better! Rant over.

My kind of rant! I asked some other witches what seeing a pelvic floor specialist did for them. I hope it encourages you to do the same, or that you encourage someone else to who has been putting up with pain or discomfort or embarrassment that they don’t need to, whether or not they’ve given birth.

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“I don’t pee that often when I sneeze, and I give all credit to my amazing magician PT. We had been working together before I got pregnant on some hip and back issues and have a great relationship. She was the first PT I’ve had (In a string of many) who acknowledged my body as being unique in proportion and having its own history (like all bodies!).

I was nervous about pregnancy due to some hypermobility and the existing hip stuff. She insisted on seeing me throughout my pregnancy and a few times after. I 100% credit her for how strong I was able to stay while pregnant and for my abs not shredding apart. Labor, pushing, and recovery went so smoothly and I owe her a lot for that. She also helped me think about how to safely take care of a baby after labor and not have much access to my core muscles for a while.

I have a great memory of visiting her with my 2-month-old. He lost his shit and needed to breastfeed right at the beginning of the appointment. She was like ‘Cool! Feed him! And show me how you do it so I can help you not mess up your back.’

If any Witches have a PT they love and are planning a pregnancy, involve them! It was a game-changer for me. I should definitely add that I have an excellent benefits package and a workplace that allows me to make health a priority! This should be standard, but you know...’Merica.”

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“I’m currently in pelvic floor PT for fecal incontinence. Very gross but the PT is very worth it! It was after the birth of my second. I was lucky because a friend who was pregnant before me had pelvic floor PT and really highly recommended it, and also made it clear that ‘Whoops, a little pee came out’ might be treated as normal postpartum but it absolutely does not have to be. Everyone should be able to hold their pee! And even more obviously, their poop! 

For me, it immediately got about 30% better, and then with subsequent appointments it is getting better and better each time to where I’m like - 85% better? - after only five weeks. The hardest part is remembering to do my assigned exercise, but when I’m consistent, the improvement is HUGE!

I was most worried about asking for the referral, because it was embarrassing for one, and because I was worried the doctor would dismiss my symptoms as a normal part of postpartum healing. Luckily they did not! I was talking to my PT about how essential her work is and how I wish it was just a standard part of care, and she said she has colleagues who work at women’s health clinics and just see people regularly as part of the workflow there. I wish I was at an OB like that!”

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“I am a pelvic floor PT evangelist to mom friends! After my first spent 4.5 hours in the birth canal and I had a 4th-degree tear from forcep use, I had to go to PT if I wanted any chance at all to help control gas (a potential delivery impact that no one talks about! Also part of the pelvic floor!) There I learned that not only is pelvic floor PT about tightening certain muscles, it can also be about loosening them. In my case, I spent about 15 minutes a session with the therapist’s hand in my vaginal canal reducing tightness and asymmetry impacting my muscles. Really got over any modestly quickly. With my second, I hit up pelvic floor PT for diastasis, and I’m currently in the second trimester for my third (and last) pregnancy and am back in PT proactively.

The midwife group that I saw for both births had a handout listing pelvic floor physical therapists in the area, and also provided recommendations on who recent patients had recommended. That part was easy - getting out of the house with my first newborn was tough, but I was lucky to have my mom available to babysit and was fueled by real terror of wtf had just happened to my body and if it would ever work again! With the second, I just took him with me and he supportively napped in his carseat during my sessions. Babies are welcome and expected for post-birth sessions, which is nice, even if you have to learn to juggle your focus.”

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“I did pelvic PT and it helped but it’s been more than 6 years and I need to go back because it’s getting worse again. There’s a great pelvic PT content maker on TikTok that I follow who did a post rounding up other PT TikTokers.”

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“I sought pelvic floor therapy because after I gave birth it wasn’t just a matter of ‘I’m leaking a little when I cough or sneeze.’ I was full-on wetting my pants out of the blue all the time. I was either wearing adult diapers or putting those doggie pads on my bed. It was a combo of the pelvic floor muscle issues and also some nerve damage down there. I didn’t even have the sensation that I had to go. I also had diastasis recti. I had significant tearing too. I was a total mess.

The place I went to was kind of cool because they had an approach that was informed by Pilates so the exercises were really gentle and you could really feel them working. I had exercises I did at home and exercises I’d do there and the manual work they’d do. Which is really awkward but for me it’s such a public area at this point.

It was kind of weird for me. It was around the same time the Larry Nassar stuff was coming out. My PT was actually doing similar stuff. There is a real medical basis for some of it that he was clearly exploiting for his own personal sickness.

My therapist advised me on this tool called a Therawand. A lot of my issues boil down to spasming in the muscles down there, and so then you can release the spasms by doing this trigger point work with this device that looks like a fancy dildo. It’s curved, you get the leverage you need or whatever to be able to work on the points. She also showed me how a lot of vaginal pain and pain SI joint in my back are related. It was fascinating how critical it is to have the balance between all of those parts.

I was wholly unprepared for what the recovery from childbirth would be, how much it sets everything out of balance. People don’t talk about it. The goal is to get the baby out, but I don’t think there’s much attention paid to the physical part of that fourth trimester period and beyond. We talk about postpartum depression, as we should, but I think it’s so embarrassing to be like ‘I am full on wetting my pants. I’m just sitting watching TV and I just totally wet my parents because I didn’t even know I had to use the bathroom because there’s so much nerve damage.’

I got a referral at my six week checkup. I had to press for therapy. I was telling my OB all the issues I was having and she was like ‘Welcome to motherhood.’ I said ‘I’m very afraid right now that I’m going to be in diapers for the rest of my life.’ She took another look and said, ‘Yeah, at best you’ll get back to 60% of your vaginal tone that you had before.’

Don’t hesitate to go to PT. It’s not too late. The 2 PTs I worked with were very kind, very reassuring and very much validated the physical trauma of childbirth in a way that my OB certainly didn’t and no one else in my life had for me. It was treated like a fairly run-of-the-mill birth from a medical perspective but still traumatized me for me and having someone validate that trauma was important to me.”

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Finally, after hearing from various witches about their regret they didn’t get PT sooner, their concern that it’s too late, their expectations that some peeing and leaving your kid at home for doctors visits are both the norm, I ran a few questions by Dr. Shefali Christopher, an assistant professor and director of sports PT residency at Elon University in North Carolina, who specializes in helping postpartum athletes return to their sport safely.

The takeaway I’m getting right now is that women accept a certain amount of incontinence in their lives and/or assume that pelvic PT is not for them.

I see it a lot. I don’t think medical providers ask the question enough. It’s so under diagnosed. So many of us think it’s normal to leak a little after jumping or running after childbirth but it’s not. What PT therapists are trying to push is making it a normal question at checkups: “How much alcohol do you drink?” “Do you leak?” That should be part of the intake.

The second thing that’s a pet peeve of mine is that there’s a lot of information out there that you should “Do your Kegels,’’ but just like any other muscle, if you work it too much, there can be a problem of not relaxing it enough. If you’re holding a lot of stress and tension in your pelvic floor, you could be leaking because the muscle is fatigued and in that case the Kegel is not necessary. Deep breathing is what is needed.
 

Something I hear a lot from friends is that they think they have separated abs (diastasis recti ) and they don’t know if they should do something about it or not. It’s kind of wild that this is so common yet poorly understood.

Are you having back pain, incontinence? Is there a reason why you’re worried to begin with? A few years ago there was a lot of fear around diastasis recti and fear of movement. It’s basically as you go through pregnancy, the Rectus Abdominis, your six-pack muscles, tend to widen and the fascia in between widens. That’s not a problem unless there’s back pain or a hernia or excessive incontinence and leaking where the muscle is supposed to support you and it’s not doing its job.

It’s just part and parcel of pregnancy and recovery from it that some people have it, some people don’t.  For the people getting surgery, it’s more aesthetic than actually functional. If someone is concerned, it is easy to go to pelvic help PT or a regular PT who has orthopedic knowledge of pregnancy and postpartum and they can try some different things to help with the back pain or whatever they’re having.

How often do you see people who gave birth a long time ago and figure they missed their chance for pelvic floor rehab?

You’re never too old. It’s never too far gone. You may look up and say “Oh crap, I should probably do something about this because I’ve been leaking for 10 years.” You can go and get the help you need. There’s no limit. 

What’s your policy towards patients bringing their kids to therapy? 

I personally love it. As a mom, I can pick up your child that’s crying and give her a pacifier and or bottle and continue what I was doing. We’re used to being able to multitask.

I would love, in a dream world, for your OB just to refer you for a PT evaluation and it’s up to you to decide how often you come, for how long. If transport/childcare is a barrier, then maybe you set up virtual appointments. That first appointment is important to tell the mom “Your health is important.”

We’re asking new moms about mental health, barely, asking about pain, then sending them off saying, “Come back next year.” The PT might connect three or four times postpartum, and sometimes they catch something like “You’re still bleeding? You shouldn’t be.”

There are so many things that can get better handled if there is this person checking in with the mom. The American Physical Therapy Association has an academy of pelvic health, and they’re lobbying on Capitol Hill that it becomes routine care.

What do you say to people who are worried about having internal pelvic floor therapy? 

Only pelvic health providers have taken the internal courses, and you may not need an internal evaluation. It’s more personalized than the ob-gyn where they just lay you down, and they only need to use the index finger. The internal exam is looking at the strength of the contraction, the endurance, if there are any trigger points. Pain with sex, incontinence, pain with putting in a tampon are not normal and you should be talking to somebody about that.

PT providers are trained to deal with patients who have had trauma. They’d be OK with saying, “We don’t have to do internal work: let’s try these external things.”

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Attn: IRL witches in LA

[Edited 1/17/23: We I temporarily paused the witchy IRL friend matchmaking service I did last summer after putting a lot of you in touch which was fun but also I ran out of steam when I got some requests for new locations and couldn’t source IRL buddies for everyone. But I got a fresh request for one location so I’m opening that back up. Specifically I wanted to know if any witches around the South L.A./Inglewood area want to get introduced to each other. The witch who wrote in has a 7 month old and says,“I’m in a couple mom groups but it's clear they are just NOT my moms (too crunchy, moms that don’t believe in medicine or sleep training, like WUT). Love to find some more like me!”

If you live in the area, are a mom and a reader and want to be put in touch with others like you, reply to this email and LMK how many kids you have and what age/s. I’ll supply the contact info to you all, and you do the rest in terms of figuring out what works. If you’ve already been in touch with LA witches but want a fresh intro, go for it!

(I am not doing this for other cities currently but feel free to see if you can find other witches in the comment section.)

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