To Kegel, or Not to Kegel?

This woman is having a great time on the trampoline. She must have a strong pelvic floor.

A few years ago my son was attending a birthday party at one of those indoor trampoline places. He asked me to come jump with him, which I gladly did-- for about three seconds. I quickly told him I couldn't jump anymore and excused myself. Many mothers can guess why.

I peed myself a little. 

I took one enthusiastic jump, and realized I will likely not jump on a trampoline ever again. The second thought that ran through my mind was, "Chalk up one more way Childbirth messed up my body."

I've given birth to two kids, and during pregnancy and in the postpartum period, I've faced: bleeding gums, worsening eye vision, sciatica, a permanently larger shoe size, backaches, mild carpal tunnel, night sweats, hormonal acne, hemorrhoids, hair loss, melasma . . .  Mothers, you know what I'm talking about; the challenges of pregnancy aren't limited to weight gain and labor pain. But since my oldest child is now 10 years old, most of these physical side effects are long gone from my everyday life. By most measures, I have felt like "myself" for several years.

Except the pee. Sometimes it happens when I sneeze or cough when my bladder is full. It's not often enough that it negatively impacts my life-- I don't at all pine to jump on trampolines. And I know that as women age, even if they haven't ever given birth at all, it's common to pee yourself, a little bit, every once in a while. Lisa Rinna does commercials for Depends looking totally fabulous, on this very premise.

It is common. But that doesn't mean it's normal. That's a distinction I'm hearing birth professionals talk about a lot lately. And that's what Chelsea Beyers PT, DPT, OCS, a physical therapist specializing in the pelvic floor muscles discussed during a recent presentation for the Treasure Valley Doulas association. She explained that the pelvic floor muscles, a thin layer of muscles at the base and sides of the interior pelvis, support internal organs such as the bladder, uterus, and bowels. They are vital in regulating the passage of urine and feces, and play a role in healthy sexual function. They provide support for a growing baby in pregnancy. They work with the abdominal and back muscles to stabilize and support the spine. They are really, really, really important.

Weakened pelvic floor muscles can be too relaxed, or too tight. One symptom of a weak pelvic floor is urinary incontinence, and that doesn't mean that you pee your pants all the time like Lisa Rinna's target audience. Just one instance of involuntary urine leakage can signify a weak pelvic floor. Other pelvic floor problems include:

• fecal or gas incontinence
  
• urinary urgency or frequency
  
• pain during intercourse or with tampon usage
  
• vaginal pain or tightness
  
• constipation
  
• pubic bone pain
  
• irritable bowel syndrome, and
  
• pelvic organ prolapse.
  

​
The brain plays a role in these issues, as anxiety over physical pain or discomfort can create a brain/body loop that exacerbates symptoms. Diet, psychology, and past trauma can also play a role in pelvic floor dysfunction.

Women are reminded to "do their Kegels" during pregnancy, to strengthen the mysterious pelvic floor. (Just the mention of Kegels is enough to make a woman secretly squeeze her pelvic floor muscles several times in a row  . . . You know you just did some).

​But not all women should do Kegel exercises. Those with a tight pelvic floor, such as long distance runners; women with a history of pre-pregnancy constipation, painful intercourse, or tampon usage; and some survivors of trauma, may actually be worsening the condition of their pelvic floor muscles by doing Kegels.

Beyers loves to see pregnant women in her office who visit her before they experience serious symptoms. Many new mothers, overwhelmed with caring for a newborn baby, and trying to heal from their births, delay getting treatment or learn to live with their new "normal." (And contrary to popular belief, women who give birth via Cesarean section are also prone to pelvic floor issues).

When Beyers sees patients prenatally, she can preemptively help them to avoid long term problems. "These are the women who won't have pelvic floor problems in the future," she says. 

Then there are patients like me, who maybe didn't know they had a problem, or have been living with pain or embarrassment for years, even decades. Beyers treats women of all ages; she even has patients in their 80's, who may be sedentary but can still benefit from pelvic floor physical therapy. She tailors her treatment to each individual woman's lifestyle and goals. Poor sleep, sexual dysfunction, self-confidence, back pain, incontinence-- just about all women can find relief in these areas with pelvic floor physical therapy. 

Mothers can enjoy trampolines. What is normal can and should become what is common. 

Update for 2018: Chelsea Beyers, PT DPT OCS now offers mobile pelvic floor therapy! She comes to you with her new company, Treasure Valley Pelvic Health. Get more information at http://www.tvpelvichealth.com

elevated birth
​Copyright 2018