Three lessons from Pelvic Floor Physical Therapy

I’ve been seeing a Pelvic floor physical therapist for the past six months.  Here’s a little background and three lessons to share from my experience.

First, I must begin with advocating for pelvic floor physical therapy to be normalized in routine medical care.  Pelvic floor physical therapy is routine care for (especially postpartum) women in many developed countries, but not in the good ole’ USA.  No doubt because it’s less normalized here, finding a pelvic floor PT specialist in your town is akin to finding an alicorn (you know not just any old unicorn but one that also flies). 

Instead, it’s more common to ignore or feel ashamed rather than seek treatment.  And (if you are at all like me) occasionally make jokes with girlfriends about how you pee yourself a little when you _____ laugh, cry, sneeze, cough, run, jump, etc... Ha, ha funny, no?  Even more hilarious might be chronic back stress or pain during intercourse.  It doesn’t have to be this way.

 And did you know all genders whether they’ve given birth or not experience pelvic floor dysfunction?  Though most obvious in postpartum and aging women this burden exists across the board.

Though my grievances have some root in postpartum and perimenopause physiological changes my first aha moment to unlocking a healthy pelvic floor came in identifying how my behavior linked to how I hold and move my body throughout the day.

I was so ready to put all the blame on my pregnancies and aging and perhaps the pull it in dance training and suck it up athletic mindset, but turns out it has a lot more to do with my anxiety, past trauma held in my body, and general uptightness.  No easy fix, but I do have a few lessons to pass along.

Lesson 1:  Diaphragmatic Breathing

Use diaphragmatic breathing to better sync your body functions.  Diaphragmatic breathing is best initially practiced in a supine position.  Lie down on your back and place your hands on your lower ribs.  As you inhale fill belly, ribs and chest and on the exhale use a slow hiss to release the low ribs down and in.  Imagine knitting your low ribs down and visualize closing some of the space between the bottom of your ribs and the top of the pelvis.

Don’t jump to anything else.  First, just breathe.

Lesson 2:  Let it go

This one is for all my Type A superheros.  I’m talking to you my fellow leaders, perfectionists, anxiety sufferers, can’t sleep until everything is done right peeps.

During my first appointment with Dr. Gopi Pillai (the aforementioned DMV alicorn), she asked if I realized I held my breath a lot?  She noted that in our hour together I was constantly holding my breath.  I was like well yeah I feel anxious about this, and I want to make a good impression.  Over the next week I would note how often I held my breath in various situations throughout the day.  And it was a lot.  Like a lot, a lot.  So even though I use breathing techniques to center myself each morning, it wasn’t enough to undo all the (up)tightness of my day.

I started by first noticing when I’m being my regular uptight self and tapping in to down regulate.  I also got back in the marketplace for a good therapist and gave myself a challenge (I mean I’m still Type A) to take a pause for 2-3 diaphragmatic breaths each time I noticed I’d been clenching (my teeth, my butt, my breath).  My conscious effort to normalize leaving laundry unfolded for a day or let a swear word fly every now and again came from this lesson as well. 

This is a lifelong lesson I’ll always be working with, but Dr. Pillai linking my behaviors to some of my pelvic floor dysfunction has been really key to how I approach the problem/solution.  I have to look whole body health and wellness.

Lesson 3:  Relax…and do your Kegels

A healthy pelvic floor is one that can release and soften as much as it can tighten and contract.  It feels counterintuitive to soften when you are experiencing incontinence on occasion, but if you are always in a state of semi-contraction the muscle is exhausted when it is time to perform.

If someone asked me to pick up a watermelon from the ground and transfer to a tall counter and then walk away from it.  No problem.  I’ve got this.  But if I were asked to carry that same watermelon around for an hour cradled in my arms and at the end of the hour lift to that tall counter.  Well that may or may not work because my muscles would be exhausted from the constant tension.  Same goes for our pelvic floor – it’s hard to recruit muscles that are in a hyperactive state.

So relax first.  Lie down and practice several rounds of diaphragmatic breathing.  Visualize releasing the muscles from below your navel to the very base of your pelvis.  After several rounds begin to add a Kegel on the exhale.  Imagine squeezing both in and up as slowly as possible.  Release on the inhale as slowly as possible. 

This is harder than you think.  Take your time.  Try it just a couple of times.  If you tend towards tightness you need a lot more time to relax in between cycles.  I often would need a full 30-60 seconds for my muscles to fully release between Kegels.  Yes read that again – up to a full minute between each repetition.  Over time progress to doing this exercise seated and standing.

So those are the lessons.  I could share more, but that’s enough for now.  No way around it this is a sensitive space to work with.  Trusting yourself to be ok and trusting your physical therapist are paramount.  Seek out a specialist in the field.  If you are in Washington, DC check out Dr. Gopi Pillai with Blueprint Physical Therapy.  I also recommend connecting online with Dr. Megan Anderson whom I saw during my second pregnancy.

Over the course of the past six months I’ve seen maybe 40% improvement in symptoms.It’s a slow process with bumps along the road.I’ll stay at it and I hope this gives readers who identify with pelvic floor dysfunction a gentle push to begin or continue your healing.