During my first pregnancy, I had to have an emergency caesarean section because my daughter got stuck in my birth canal after 45 minutes of pushing. My gynecologist sarcastically calls it ‘the best of both worlds’ because I had to give birth until she was in labor before emergency surgery.
My pelvic floor doesn’t see it that way. As an added bonus to the physical trauma I endured, the night after I gave birth, the cloth in which my newborn daughter was tightly wrapped was loosened, covering her face. She was crying, actually screaming, but my partner who suffered from sleep apnea slept away. I thanked my lifelong ability to wake up to the sound of a pin for helping me regain consciousness at that moment. Before I could remember that I had a new 12-inch incision across my waist, I stumbled forward to help my newborn.
Days later I woke up covered in blood with a split c-section incision. My mother threw up when she saw my partner cleaning up the wound. Then I realized I had re-traumatized the location when I adjusted my daughter’s swaddle. After a 6 a.m. ambulance to the ER, a return trip to the ER a week later due to more bleeding, a subsequent infection, drainage appointments, and two weeks of motherhood, I finally began the journey to physical healing. But for more than six years afterwards I suffered from incontinence.
Since giving birth I have been leaking from laughing, sneezing, coughing, jumping on the trampoline with my kids or even screaming along to my favorite song in the car. Sex with my husband was often so painful that we had to stop. When these problems started, I had not yet started my graduate studies in sexual and reproductive health and did not know that a C-section could cause a pelvic floor injury.
I thought pelvic floor dysfunction only happened to those who had vaginal births. I was wrong.
I now know which pelvic floor therapy implies working with a physical therapist to perform exercises such as Kegels, squats and stretching, and using other techniques such as hands-on massage and vaginal dilation, could have helped me with this problem a long time ago.
The problem did not get better as time went on, but actually got worse. Over the course of a few months, a childless friend of mine urged me to tell my obstetrician that I was struggling with pelvic problems—and to use the information I’d gathered during my college education to help me advocate for myself. My gynecologist was happy with that, without thinking about it. Being backed by private health insurance, I was ready to get my pelvic floor in order.
The first session with a pelvic floor therapist can be the most intimidating. It consists of analyzing the response of the pelvic floor to different stimuli to draw up a treatment plan. There are also ‘homework exercises’ you can do outside of therapy sessions, such as Kegels and stretches.
I was shocked when my urge to urinate decreased only after the first week, from an average of twelve (yes, twelve) times in a 24-hour period to an average of nine times in the same period. (People usually urinate six to seven times in an average of 24 hours.) As an added bonus, for the first time since those witching hours with a newborn seven years ago, I slept more than six hours without waking with the urgent need to cope.
I was addicted to this therapy that I had previously been so misinformed about, even though I had spent almost a decade researching and advocating for sexual health. Strengthened by my personal experience, I spoke with Ruth Macy, a pelvic health physical therapist and co-author of Your postpartum bodyto clear up some common myths and misconceptions about pelvic floor therapy for others who may be in a similar position.
Is pelvic floor therapy only helpful for postpartum people who have had a vaginal birth?
Pelvic floor therapy is useful for anyone who is pre- or postpartum, as well as those who have not yet given birth. Pelvic floor therapists can help people who are concerned about the health of their bladder, bowel, pain or changes in sexual function, gynecological or urological cancers, and colon cancer. People in gender transition may also need pelvic floor therapy, Macy said.
Is pelvic floor therapy traumatizing?
Although pelvic floor therapy can be difficult for survivors of sexual abuse or for those who have suffered childbirth or postpartum injuries, the history of trauma usually surfaces during the consents made during the initial intake session. For example, patients can opt out of internal vaginal examinations. Often my therapist checked my pain while we did exercises and always asked my permission before trying anything new. Pelvic floor therapists are trained to treat their patients with care and respect and to confirm their consent during treatment. Macy told me too RNG that healthcare providers must respect patient autonomy and “have safeguards for stopping treatment if the patient stops responding or seems to want to ‘get through it’.”
Is pelvic floor therapy scientifically substantiated?
Pelvic floor therapy is used since the time of ancient Greeceand the field has come a long way even since the mid-20th century. Pelvic health is one of the fastest growing areas of clinical research and has a strong and growing body of evidence behind it.
In the 1940s, Margaret Morris wrote [a ballet dancer and choreographer] and Minnie Randell [her mentor and a midwife/physiotherapist] found that strengthening the pelvic floor helped reduce leakage in dancers,” said Macy. “Since then, there have been many decades of ‘how to influence the pelvic floor’.”
Macy added that pelvic floor therapists can become board certified through the American Physical Therapy Association, but it is not required to practice.
Are women the only people who can benefit from pelvic floor therapy?
No! Children and men may find pelvic floor therapy helpful if they struggle with pelvic floor or related problems. Macy says men most often seek pelvic floor therapy for incontinence after radical prostatectomy. But men can also benefit if they struggle with sexual dysfunction, any disturbance related to the prostate and testicular pain.
In children, pelvic floor therapy is often recommended if there is bedwetting, urgency, daytime incontinence or constipation. The difference for children is that they do not have internal exams. Therapy consists of behavior change and/or exercise.
Is pelvic floor therapy only useful for pelvic floor problems?
One of the biggest misconceptions is not taking into account the ways in which the Pelvic floor is connected to other parts of the body.
“The pelvic floor is a story, because it reports to different parts of your nervous system,” Macy said. “It’s more likely to be dysfunctional than other muscle systems. It needs to be taken into account.” [unmanageable] back, pelvic, sacroiliac joint and hip pain that does not respond to conventional treatments. It can help with any deficiency in walking, transfers, running and more. It functions as part of many systems, so I see it involved in many musculoskeletal problems.”
For me, the benefits of pelvic floor therapy were enormous. They helped my quality of life, my posture, my sleep and my sex life. The myths are just that: myths.
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