#10: Everything you need to know about pelvic floor physical therapy.
The pelvic floor exists, is important, and can be healed with pelvic floor physical therapy.
The truth about pelvic floor physical therapy is that it's hard to find but so helpful.
Why am I writing about pelvic floor physical therapy?
After I gave birth to my son 3 years ago, I quickly learned that not only is there a part of my body called The Pelvic Floor, when the pelvic floor ain’t happy, ain’t nobody happy. Once I realized there was a problem—and according to the internet, more than 50% of women experience dysfunction—I wanted to fix it. Naturally. (Note, men can have pelvic floor dysfunction, too!) I bet I’ve spent over a thousand hours on my pelvic floor between physical therapy exercises, research and doctor’s visits.
What did I learn about pelvic floor physical therapy?
Pelvic floor physical therapy itself is easy and effective, but finding a knowledgable therapist was not. There is information online, but the advice varies wildly from “expert” to “expert” and is often contradictory. The Kegel Queen’s program involves a crazy clenching exercises she calls the Super Kegel. Katie Bowman of Nutritious Movement advocates for a more holistic approach of proper footwear, alignment and stretching and says squat instead of kegel. Christine Kent of Whole Woman goes as far as to say the kegel actually makes prolapse worse, and that prolapse can be relieved by restoring the body’s natural lumbar curve. Tasha Mulligan over at Hab-It takes a physical-therapy oriented approach and says pelvic floor health requires strength and proper functioning of the abdominal muscles, the hip muscles, the low back muscles and the pelvic floor muscles.
Although these women have different takes on what leads to pelvic floor rehabilitation, they agree on one thing: surgery is a last resort. And these women also offer hope. To anyone else who all of a sudden found going to the bathroom more difficult—or to happen more often, or to happen when she didn’t want it to happen—a little hope goes a long way. Pelvic floor dysfunction is painful, uncomfortable, limiting, embarrassing, disappointing and—for most of us—a total surprise.
The quality of healthcare provider varies as much as the online research, even within the pelvic floor rehabilitation specialty! The first PT I saw was based out of a hospital, and gave me a regiment of squeeze-and-hold kegels, marches to strengthen my transverse abdominis, and bridges to strengthen my glutes. She also showed me how to close my 4 cm diastasis recti by tying a sheet around my abdomen and doing sit-ups. Knowing what I know now, her treatment plan was superficial and narrow in scope.
I did get a little better, though, maybe more as a result of time than the exercises, but then when my son was 4 months old and I was anxious to get back to my athletic self, I went rock climbing. I don’t even know exactly what it was about the chimney route I tried to climb that hurt me so bad, but I could feel it while it was happening. That’s when I took matters into my own hands, and first tried Christine Kent’s Whole Woman approach.
I really appreciate that she correctly orients the pelvic floor as actually being vertically oriented so that the pelvic organs are stacked on top of the pubic bone as opposed to being suspended precariously over the opening to the vagina, ready to fall out at a moment’s notice. That “floor” or “basket” view of the pelvis is actually pretty ridiculous once you start to think about it.
Whole Woman educated me about the importance of posture and why the squeeze-and-hold kegel makes no sense, but the exaggerated lumbar curve she recommends gave me low back pain. After Whole Woman, I tried Tasha Mulligan and finally started to understand how physical therapy of the four muscle groups she mentioned are all important in treating pelvic floor dysfunction. In fact, pelvic floor health is more about the other muscle groups than the pelvic floor muscle groups.
With Tasha’s Hab-It DVD and religious exercising on my part, I did get my body rehabbed back to the point where I was’t feeling pain or discomfort most of the time. The part of prolapse that involves degradation of the vaginal wall never gets better, but muscle strengthening can help compensate. And then passed the most stressful year of my life, after my son and I left his dad and spent a year embroiled in court drama.
Stress is a killer on pelvic floor health. It’s bad for overall health, but I think as women, we hold our stress in our pelvic floor. My diastasis opened back up and I lost all abdominal strength. As a result, the big compensatory muscles kicked in and never turned back off and my psoas started spasming so badly I could hardly walk. Also as a result of the diastasis was a total lack of support for my pelvic floor. Plus, my hip socket got locked into my pelvis somehow. I started having trouble going to the bathroom again, was in constant pain no matter what position I was in, and was so depressed to have lost so much progress.
So it was back to rehab for me. I found a new doctor, who helped me get on some supplements for support, gave me some tricks for making going to the bathroom more comfortable, and started me on a pelvic floor exercises routine. I improved with her for sure, most notably in the area of vitamins and minerals because it turns I had low estrogen, low vitamin D, and tapped out adrenal glands.
It was around this time that I found Katie Bowman's well-written blog and her Nutritious Movement exercises. I read the book Diastasis Recti, bought the Nutritious Movement for Pelvic Floor DVD, and started doing the exercises. They focus more on stretching than strengthening, but as Katie explains, muscles that are too strong can be a problem, too. My psoas relates. I also took her advice and immediately stopped wearing heels. My adorable ankle boot collection is gathering dust in my closet, sob sob, but flats are more comfortable, it not cuter. Actually, Tom's are really cute and they're washable.
I was still totally limited in my activity to rehab exercises, though, and struggling with daily muscle spasms that left me hobbling around in this weird slightly bent forward position. My sports massage therapist got tired of observing my lack of progress and strongly recommended I go see a regular PT she knew, who diagnosed the hip mobility problem, and really started turning things around for me.
Muscles take a long time to get the way they get. My pelvic floor dysfunction probably wasn’t just caused by my pregnancy, and Katie Bowman is really adamant that pelvic floor dysfunction in general is not caused by pregnancy. She makes her case by pointing out that childless women and men both have dysfunction. For me, years of wearing heels at work (Katie Bowman), living with the unaddressed hip immobility, the diastasis, chronic low estrogen and failing marriage stress all set me up to have way rougher postpartum period than I anticipated.
Pelvic floor health is a way of life, and it takes time to get there. First, compensatory muscles have to be calmed down and the inflammatory process stopped. Underlying issues like diastatis and immobility need to be addressed. And then starts the slow and steady process of gradually increasing the intensity of exercises over time, and modifying habits (no high heels!) to support the progress. Initially I was so weak, and then less weak and now I’d say that while I’m not strong yet, I’m no longer weak. It’s my goal to be strong again. That’s why I was researching Crossfit the other night.
It’s been 3 years since I started on this journey, and at the rate things are improving for me now I'm thinking that asking for freedom of movement within another year is reasonable. With education and diligence and hope, rehab is possible for most people. Certainly for way more people than currently know it’s possible.
What did I accidentally learn along the way?
Women are amazing. Each of the women I mentioned above had some personal experience that drove them to help other women. Tasha was a triathlete and physical therapist who experienced bladder prolapse after her first child, and was like, WTF—I’m a triathlete. So she made an exercise routine to rehab her body, and shared it with other women. Christine Kent had surgery to address bladder incontinence and the result was uterine prolapse. Rather than agree to more surgery, she sat down with old medical textbooks to figure out if there was any alternative. The Kegel Queen was a nurse who got tired of seeing women get ineffective surgeries. Katie Bowman is studying how to PREVENT pelvic floor dysfunction. Thank you to these woman for caring about other women, for generously sharing their knowledge, and for bringing awareness to an issue that affects all women but is somehow never talked about. Women should talk about things more.
Speaking of which, a physical therapist named Brianne Grogan wrote a book called Lady Bits that talks about all-things female. I appreciate that she writes about pelvic floor health as it relates to sex, and even prescribes a warm-up routine for better sex. I'm a single mom, so um yeah haven't really needed to try that yet, but the book is on my shelf just in case...