Keep Your Core in Your Pants
I came upon this blurb from The Motherhood Movement on Instagram yesterday. Despite about 5 attempts to repost with my own caption, I decided to add a little more content and just throw it up on the blog.
The post is pretty simple: Work your core, dear. It's nice for your organs to stay inside your body. My thoughts on acceptable/beneficial vs. pointless/harmful core work have definitely evolved since I started working with clients back in 2005. Unfortunately, however, I would say my own pregnancy and postnatal recovery was the true eye-opener. I had attended some great pre- and postnatal conferences through the years, but the new focus on my own abdomen and pelvis put things into perspective. It also made me consider all the other pelvic issues people suffer through.
Through my own experiences working alongside physical therapists and training moms at all stages, I have long believed every woman needs at least 2-3 postnatal sessions with a physical therapist. So many long-term issues affecting quality of life could easily be avoided, healed, or improved with a simple assessment and commitment to a few basic exercises before things really get bad. Obviously the TMM post refers to prolapse (bladder, bowel, urethra, vagina, rectum, etc.), but it made me think about my own experience in tending to the supportive structures surrounding all those bits.
Two months after having my son, I was lucky to be referred to a physical therapist, specifically one who is board certified as a Women's Health Clinical Specialist (WCS). I developed some pudendal nerve pain (unpleasant tingles from lady bits down left hamstring) around 4w post partum; there was also the hypertonicity of my obturator internus (overly active muscle within the pelvis). To round out the trifecta, I also had a moderate diastasis recti (widening of space between left and right muscles in the six-pack), which wasn't too big of a concern, especially since this can sometimes take months to repair. My therapist helped me address all these issues.
After the second session with my PT, it was obvious that the simple exercises she prescribed really took focus, and of course, consistency! I needed a neural re-boot after 9m of bodily changes, the trauma of childbirth, and, of course, my body trying to put the pieces back together. The only way to improve was to practice, practice, practice.
With the new focus on my abdomen, back, and pelvis, it became apparent that 25+ years of IBD and IBS were another factor in my dysfunction. I probably always had a mis-firing of certain muscles (instead of "1, 2, 3", it was more like "3, 1, 2"), but the baby thing brought my dysfunction front and center. Aside from scrambling basic motor patterning, chronic inflammation in the gut can really mess with your breathing. But it had been my normal for so long, I never really knew anything different. Throw in years of all that extra movement and breathing I like to do (hello, exercise), and the dysfunction became more and more engrained.
I started most sessions with a gentle warmup, just a few minutes of walking on the treadmill. I was instructed to focus on my newly acquired, basic pelvic floor activation while working with a bit of impact (walking) and slightly elevated breathing/heart rate. I remember barely being able to control my bladder; It felt like I was hiding a wet sponge in my underpants. If I walked too fast or lost my focus, a few drops of urine leak out of that sponge; trying to squeeze things just made the problem worse. How the hell do people get back to running, let alone walking, so soon after having kids?
Although I did plenty of prescribed rehab at home, the majority of my time in PT, however, was spent in an exam room. "What?" you ask. "I thought it was all exercising and stretching on some oversized massage table!"
The majority of my time in postnatal PT was spent pantless, with my PT performing internal manual therapy. Yes. A stranger's finger was in my vagina for 30 min, twice weekly. Don't be creeped out; she is a doctor, after all.
Initially, the internal feedback was important so she could understand if I was activating the right muscles at the right time. She could then properly instruct me to do certain exercises, fully clothed, in the open therapy area. Later sessions focused on internal trigger point therapy (imagine a finger massaging a wicked knot in your muscles; yes, still in the vagina). Unfortunately, the location of my misbehaving muscle was best accessed internally. Other modalities included dry needling of my abdomen and hips, and TENS therapy on my crotch and groin. Yes, jokes abound.
I bring up this very condensed version of my experience because :
#1: People who need help don't know help exists, AND/OR
#2: Once people find out about said help, they are not aware of what types of therapy may be involved, AND/OR
#3: They don't think the time or monetary investment in therapy will produce tangible results, AND/OR
#4: They get frustrated with the simplicity of the exercises, and progress can be difficult to measure. You don't strengthen your pelvic floor like your biceps, for example. Where's the burn??? AND/OR
#5: When they DO find out about the possibility of having awkward or uncomfortable therapy (see aforementioned finger comments), they decide they no longer need help.
Just like me and my IBD, most people have become so accustomed to their pain/dysfunction/abnormality, they have forgotten how something like incontinence, or painful sex, or not being able to sit on a hard chair really affects their quality of life. I was in the PT office when a patient dropped off flowers as a thank you to one of the therapists. This patient had been enduring painful sex with her husband for 30 years. 30 years! After finally asking for help, a few weeks of work eliminated her pain.
I don't care if you're 25 or 65, man or woman, have pelvic pain or dysfunction; never had kids or popped out your fifth 20 years ago; delivered your child vaginally or surgically; you rush to the toilet because the urgency is so high and your confidence is so low; maybe you're still peeing your pants when you cough, laugh, or sneeze? Sorry Brooke Burke, Poise can definitely help, but a proper assessment is the best place to start.
The suggested treatment might not be pleasant, but it won't last forever. These folks are professionals and their only goal is to help you live a better life. Don't be embarrassed to ask your gynecologist, urologist, or primary care physician about your symptoms. Or you can go straight to a pelvic physical therapist. Did you know you don't actually need a referral for an evaluation by a physical therapist?
Although my own physical therapy ended awhile ago, I continue to work on some of the basics through regular pilates and yoga practice, massage, and yes, those frustratingly simple exercises I learned 2 years ago. I still struggle, and keeping up with the basics can seem like a time suck. But it might just help you keep your core in your pants.
If you and your pelvis find yourself in need of a help and live in Louisville, KY, please reach out to the amazing team at Dunn Physical Therapy. Aside from other specialties, they assist in women's health, men's health, and pre- and postnatal care.
Check out their website for a list of a few of the symptoms and diagnoses they treat.
You can also follow one of their rockstar therapists on IG @tothepelvisandbeyond