Tag Archives: pelvic floor physical therapy

Birth Injury – Common But Not Normal

Rant alert.

Each week women come into my office with a troubling problem that their doctor, midwife or even physical therapist has told them is normal.

I am here to tell you that:

Wetting your pants is not normal. Ever. Not if you just had a baby. Not if you are doing Crossfit. Not if you are walking on the beach. Not if you sneeze. Not if you are pregnant. If you are wetting your pants, there could be a few causes. The main ones are each that your pelvic floor muscles are too strong and tight or too weak and lax.

“Urinary incontinence,” the technical term for “leaking” or “wetting your pants” is common however. You don’t need to panic or feel bad. Many women experience less bladder control during pregnancy and birth. It is not a life sentence or an inevitability.

Seeing your organs from your vaginal opening is not normal. If, in any position, you can see your cervix, your bladder or bulging from your rectum into your vaginal opening, this is not normal. If you have to manually push your organs back up and in, that’s also not normal.

These are all signs of organ prolapse. Unfortunately, because many doctors don’t know what to do about organ prolapse, they tell many women that it is normal. Many women avoid sex, feel unsettled and sad about the state of their lady bits, and generally confused by the disconnect by what they are feeling and what their health care provider is reflecting back to them. It doesn’t have to be that way.

Pain during sex or avoiding sex is also not normal. Total aversion towards sex, pain upon penetration, or pain internally is not normal. “Low libido” is a term that seems to define a fixed thing, but actually refers to a whole combination of factors that could contribute to feeling what you might throw into the category of “low libido.”

All of these are common. There are many reasons you may experience pain during sex, including lack of lubrication (nursing requires a lot of moistening), lack of sufficient arousal time, lack of emotional connection, scar tissue that burns or is pulling the pelvic muscle tissue in different directions. “Low libido” is a term that seems to define a fixed thing, but actually refers to a whole combination of factors that could contribute to feeling what you might throw into the category of “low libido.” Aversion towards sex may be the visceral fear of returning to the area that had to completely reshape, resounding echoes of birth trauma, a changed view of what you want out of sex and relationship currently or physical birth injury that affects your relationship to your body.

The main reason to understand that these things are common but not normal is so that you can GET SOME HELP. If we see them as normal, that basically infers that we need to suck it up and live with it. When we understand that it is common, but not at all optimal functionally, we can do something about it!

SO, What can you do about it?

Healing is multi-faceted and individual, so I cannot give you one answer that fits for every woman. However, here are a few starting points.

1. If you haven’t already, explore yourself in a hand mirror. We often have a distorted image of what we look like, because of how we feel. Really look at your vulva, and see how it is. Allow for the feelings that come up. There may be real grief, surprise, or even relief. This will take everything out of the realm of imagination and allow you to see things as they really are.

2. Follow your intuition and what you see. If you KNOW something is not right, it isn’t. It doesn’t matter if someone tells you you’re are fine and normal. There is a reason that you are not feeling fine or normal. Find a pelvic floor physical therapist trained holistically by Tami Lynn Kent or a Sexological Bodyworker who has experience in working internally and seeing the whole of who you are. You need someone who can work sensitively. You may experience an emotional release or a resurgence of grief about your birth story. This is part of the healing process.

3. Be patient but not complacent. Being a new mom can put you in a fog, where everyone else’s needs overshadow yours. In fact, you may only be cursorily experience these symptoms- really feeling them. Some women don’t notice they are avoiding certain positions during sex because of pain, for instance. Taking care of an infant is a full-time job, balancing that with work and partnership can be overwhelming. It is understandable that some of these physical needs have slipped into the backdrop. But now that they are in your awareness, take action. Don’t push through exercises that you have a sinking feeling are exaggerating the symptoms you are feeling. Reach out for the help you need.

4. If you had a traumatic birth experience, not what other people consider traumatic, but what FEELS TO YOU like traumatic, it is CRUCIAL that you get support to process it. Pam England, author of Birthing from Within, offers online Birth Medicine sessions. I study with her, and I cannot recommend her highly enough. She is a true wise woman- she has worked in birth for over forty years and has medicine for each woman and each birth experience. I also highly recommend Somatic Experiencing trauma resolution. Better yet, someone trained in pelvic floor work together with trauma work. Resolving birth trauma is at the root of healing symptoms. Your body won’t let you skip this step. Invest in the step soon!

It is important that we “normal”ize the range of women’s birth experiences, including ecstatic ones and orgasmic ones, so that as women we expand our vision of what birth can be.

Pass this information on to your friends.  Women everywhere need to know that full healing from childbirth is possible, with the right support!

*Thanks to Jane Austin for this important linguistic distinction.

Yoga Post-Partum- Put Away Your PreNatal DVDs

When new moms feel that they are ready to get back to their yoga practice, many ask me if they can start with their Prenatal Yoga DVDs.

It sounds like a good idea, but actually preparing for birth and recovering from it are completely different projects.

When we prepare the body for birth, we focus on opening up and widening the pelvis.

When we recover from birth we need to pull everything together. Our pelvis is already wide enough after 9-10 months of pregnancy and childbirth itself- the last thing we want to do is stretch and open it more.

The post-partum period, especially the first three months, is a great time to expand your view of what fitness is.  Rather than focus on getting back in shape, see if instead you can focus on building your vital energy. Vital energy is the amount of life force that it took for you to grow a new life inside you and then birth that life into the world. Now you are sustaining that life through your attention and care, which affect you on a physical, emotional, mental and spiritual level.  Trying to get back in shape when you are already low on vital energy doesn’t work that well and may actually be more depleting.

But that doesn’t mean that you have to do nothing!

The two main ways to build vital energy are to rest and to eat nourishing, mineral rich foods.

Another great way to build your vital energy and to begin building your abdominal and core awareness is through conscious breathing.

In fact, conscious directed breathing is ESSENTIAL for your recovery. It is the building block for re-establishing strength in your pelvic floor, so that you can avoid or alleviate symptoms like incontinence, prolapse, and simply feel supported so that you can resume all the activities that you love without the risk of injury.

Before you start a movement practice, you want to be sure that you have re-established a connection with your pelvic floor and your abdominals. You also want to make sure that you do not have a diastasis, which is a split in your abdominal wall, before you begin. You can check yourself- this video shows you how.

So if you are looking to begin a yoga practice again after having a baby, put away your prenatal yoga DVDs and start with directed breathing, gentle spinal movements, and remember that your focus is on pulling everything back together. You may need to do some rehabilitative core stabilizing before jumping into something that looks like the yoga you are accustomed to.

Changing Post-Partum Culture- It’s Not Just a Women’s Issue

I was thrilled to be interviewed by my friend and colleague, Lara Catone. She is a yoga teacher and Sexological Bodyworker who also works intensively with women.

In this free podcast interview, we talk about:

-women’s pelvic floor health
-the difference between sensuality and sexuality
-pelvic floor physical therapy
-the role of orgasm in birth- it’s not what you think
-how female ejaculation is related to birth
-the fourth trimester
-eliciting erotic trance for birth

It’s pretty cutting edge- a lot of material that is at the forefront of women’s health- embodiment. Feminism 301! Enjoy- Changing Post-Partum Culture with Lara Catone.