What I Learned From My Pelvic Floor Physical Therapist.

Here’s the deal, until I was pregnant, I hardly knew the pelvic floor existed. Now it affects everything I do. How I squat to pick up Freeland, how I breathe when I run, how I go to the bathroom, how I feel when I have sex. And I majored in human anatomy! So, chances are, I’m not the only one who had no idea! So, for the sake of everyone out there who doesn’t know or didn’t know you had muscle and tissue down there that affect a lot of things…this post is for you.

Why did I need to see a physical therapist?

Short answer: I wanted to! Also, I knew because of my tear during Freeland’s birth I needed extra rehab. I wanted to make sure I didn’t have any organ prolapse or wasn’t in danger of getting one if I overdid it in the gym or running. And finally I was still peeing while running.

Other reasons you could ask for a referal to see one:

Peeing / leaking at all during normal daily activities or working out.
Not being able to control gas.
Needing to pee too often.
Any type of pelvic pain.
Pain during sex.
Inability to orgasm.
Any feeling of organs “falling out”.

First appointment:

Ok, so most people don’t think of a physical therapist as someone who gives a pelvic exam…UNLESS that physical therapist is a women’s health, pelvic floor specialist. Thankfully I had a decent idea of what to expect thanks to Krystal at Expecting and Empowered. (Please check her out on Instagram for daily laughs and lots of education)

First, I filled out a questionnaire with lots of REALLY personal questions.

Do you struggle to hold in urine, bowel movements, gas?
Do you have any pain during sex? Any trouble having an orgasm? Any history of sexual abuse?
It goes without saying but BE HONEST. They can’t help fix what they don’t know is wrong.

Next, we went over the questionnaire in more detail. How often do you urinate? What does your poo look like, when do you struggle to not pee your pants etc.…you get the idea…lots of details.

Then, she did a pelvic exam to check the muscle strength, endurance, and position of the bladder and uterus. She had me do a fake cough to check for prolapse (the descending of either the bladder, uterus or both). Turns out, I did have a small prolapse of both (not told to me by my OB).

She also checked my ab separation (diastase recti) and the engagement of the transverse abdominals underneath by having me lie down and do a crunch. By placing her fingers between abdominal rectus (the six-pack muscles) she could tell how far apart they had spread and how deep the separation was.

Other things she checked on me were glute and hamstring strength as well as hip strength (abductors and adductors).

Exercises with biofeedback:

Following the exam, we went to work. All the following appointments were mostly exercising with the exception of a midway exam to check my progress after I had struggled with a chest cough for a week. (Coughing creates a lot of pressure on the pelvic floor – hince why you tend to pee a little when you cough or sneeze a lot).

To do the exercises I was given a small sensor, about the size of a roll of quarters, with a cord that attached to a computer. After inserted I redressed and started with simple squeezing exercised that sent feedback to the computer for me to see the strength and endurance of the muscle flexing (at which point I was totally nerding out – there is a reason I majored in kinesiology).

* It is so cool because you can do all the kegals you want but if you aren’t doing them correctly, or aren’t actually engaging the right muscles, you are wasting a lot of time. This helped me know exactly what it felt like to engage it properly and gave me so much more control!

Examples of different exercises (I started doing all of these lying down, then progressed after a few appointments to sitting, then standing):

Proper breathing – inhale to release the muscle tension / exhale and engage
Trying to flex only the front (like holding in pee) and then only the back (like holding in poop)
Flexing different amounts – lightly to 100%
Flexing for time to work on endurance
Knacking (flexing before coughing – or sneezing)
Flexing while doing hip abductions

After about 8 appointments using the biofeedback sensor while advancing to exercises like squatting, step-ups, sit-to-stand, it was time to add weights!

Yep vaginal weights. Here’s a picture so you can get the idea. You wouldn’t think the addition of just a few ounces would make that much of difference but oh how wrong you would be!

My last appointments were me trying desperately to hold even the lightest one of these weights in while practicing squats, side lunges, squat jumps etc. Usually doing the exercise until failure (aka not being able to hold it in any longer). It was hard! I would literally sweat and bring a water bottle…that’s a lot of muscles to work for an hour!

Moving on:

After seeing how fast my core had healed my PT was hopeful that I would be doing some running with the weights by the end of my sessions. Unfortunately, I didn’t make it quite that far. But here’s the thing, once you’ve had a baby, you’re never really DONE rehabbing. Just like having an injury that is healed, it will always need to be strengthened, exercised, and considered when working out.

I did purchase my own set of weights to continue to work with at home. You can use them while doing your normal day-to-day activities for a max of 15 min/ day to strengthen or you can use with exercises as a workout.
I will continue (and probably always and forever) think about my breath and core engagement when I run – inhaling to relax / exhaling and flexion.
I will also be continuing my strength program which includes core and pelvic floor rehab from EandE.

Running Goals:

May 18th – 5k. I hesitate to put a time goal on this because ultimately my goal is to be able to run it well with ZERO leaking. But, of course I have a time in the back of my head. I’ll let you know come May 18th if I hit it ;).
Originally I had hoped to be running a half-marathon in the fall and a full in January (Houston to be exact), but I’m not sure that is realistic anymore. If I continue to make progress over the summer and half marathon comes up, there is a good chance I will try to train for one.
That being said, I’ve come to the conclusion that there are so many factors that could dictate if I run a full again any time soon. My husband could deploy, I could start training and realize I need to step back, we could decide to have another baby sooner rather than later ;)….?

Summary:

5 Things I’ve Learned from My Pelvic Floor PT (both online and in person – yes, I consider Krystal my PT too because I’ve learned so much from her!)