Postpartum health has been a huge, buzzy topic lately, which is good. After all, pregnancy and birth take a lot of you, and mama needs to recoup.
But there's one area that's been under-reported: What really happens during pelvic floor physical therapy sessions.
I'm not talking about jade eggs or the usual Kegel squeezes you do as you're using the toilet. I'm talking about actual rehab with a pelvic floor therapist. Not sure what that's all about? Don't worry. I didn't know either, but eventually I got my own experience.
So to help you understand what pelvic floor rehab really is about, TMI or not, here's my story with pelvic floor therapy to get my downstairs back in shape after birth.
After my second child was born, I was diagnosed with a rectocele, a small divot in the wall of tissue between the rectum and the vagina that can cause discomfort when using tampons, difficult bowel movements, and not-quite-right sex. I tried to remember doing my Kegels, but after two years, my lady parts still didn't feel fully recovered.
So with the vague fog of babydom behind me, I returned to the midwife I was seeing before my children were born, and she suggested I see a pelvic floor specialist. Forehead smack. I knew that pelvic floor therapy was a proven method for postpartum recovery, but in the haze of caring for children I somehow didn't see the forest for the trees—I was winning at caring for them, but utterly losing at taking care of myself.
In many parts of Europe, postpartum pelvic floor rehabilitation and therapy is compulsory—a built-in part of healthcare that women who have recently birthed babies have easy, often free, access to. Termed 're-education', these therapy sessions help to reorient the pelvic floor and strengthen the muscles that worked to hold up, and then push out, a baby. Arguably, this is important, since your pelvic floor is integral in keeping your body stable, supporting your bladder, bowel and uterus.
Paris-born yoga teacher and postpartum bodyworker Lara Kohn Thompson said it best: “I'd never seen an incontinence aisle before I moved to the United States—in France, they just don't exist because everyone is much more aware of taking care of postpartum issues".
As I entered the office of the therapist I ended up choosing, I realized that I had absolutely no idea what to expect. Was this an out-in-the-open, public kind of therapy where I'd lay fully clothed on a table and do Kegels while Bon Jovi played in the background and a geriatric woman used a foam roller nearby? I said a silent prayer for an alternative scenario, and upon being greeted by Gopi, my therapist, and ushered into a private room with a door that locked, I exhaled.
First, we went over my current physical state, both my pregnancies and deliveries, my fitness level (moderate), my diet (normal), and my alcohol consumption (yes, please, fill to the top). Then, with grace, care and utter practicality, Gopi explained that the first phase of her treatment would involve some internal work so she could assess the condition of my vaginal tissue and muscular ability.
She left the room, I undressed from the waist down; and we'd be ready to rumble, so to speak.
How strange it was to chit-chat about upcoming weekend plans with a total stranger who was gently probing your insides. But that's what I found myself doing while Gopi informed me that she could feel the scar tissue from where the stitches healed, and that she could also feel the rectocele.
We then tested the strength of my pelvic floor muscles. “Squeeze my finger, like you're trying to draw it up inside you", she instructed. I squeezed. “You're going to have to work harder than that", she chided before giving me life-changing Kegel instruction. You know that 'stop your pee mid-stream' description for the Kegel exercise? Well… It's not that easy—your sphincter muscle is also integral to a productive pelvic floor squeeze.
That's right: you have to put your butt into it.
What's more, Gopi told me that I should do the Kegel exercises lying down first, because I wasn't strong enough to do them correctly when standing up.
Gopi also assessed my hips, legs, lower abs and ribcage. While I thought about my pelvic floor as an area that was covered by my underwear, it actually encompassed a huge amount of my body, and doing abdominal work on my lower ribcage area turned out to shift things the most for me—it relieved tension in my shoulders, which made my lower body feel more comfortable.
I worked with Gopi once a week for about 6 weeks—the amount of time covered by my prescription from my midwife. During these sessions, I got to tune into my body, recognize sites of discomfort or weakness, and plot out a plan to strengthen said areas. By the second session, my body awareness was heightened, and by the fourth, my pelvic floor strength had improved to the point where we no longer needed to do internal work. By then, activating my pelvic floor while lifting or doing other kinds of activities became second nature.
Doing Kegel exercises correctly brought a whole new level of sensation back to my lady parts—a huge plus, of course. But the real reward has been the ease and comfort I've been feeling in my entire body. I have less back pain, I feel stronger, and I can exercise with a much deeper body awareness than I've ever felt before. And can we assume that the newfound definition in my abs is proof enough that I've been working my muscles as a deep, effective level?
Gopi says the true aim of pelvic floor therapy is to get the body back to basic function. You shouldn't assume that feeling discomfort, peeing when you sneeze, or feeling pain during sex, is 'normal,' she says. “Pain is not normal; it's disfunction." And if you're experiencing pain, then pelvic floor therapy could possibly help -- whether you delivered your baby a month or ten years ago.
I've shared my story here in hopes that it helps even a handful of women recover more quickly and completely after their babies are born. We give up so many things in the name of motherhood, and most of them willingly. But our pelvic floor health doesn't need to be one of them.