-Kathryn Haines, CPM
Pelvic Floor Therapy Demystified
My amazing pelvic floor was not so amazing after carrying three babies. After my second baby, I managed to control and then stop occasional loss of urine by doing kegels. When I experienced urine loss after my third birth, I assumed that it was only a matter of time before I was dry again. As the months and then a full year went by, and I continued to change pad after pad after pad, I became concerned. A bottle of tea tree oil and vinegar by the toilet helped keep the odor away but there is something very discouraging about being incontinent when you are thirty-five.
At a visit with my local midwives (midwives are my go-to for well-woman care), Mairi and Erin asked if I had any other questions. I disclosed my incontinence and they said suggested I see a physical therapist who specializes in pelvic floors. A few weeks later I sat sheepishly in Pat Strott-Wheatley's office, marveling over the fact that I had been so busy taking care of my three little ones, my husband, and the house (not to mention midwifery!) that I had forgotten to take care of myself (sound familiar anyone?).
In the first visit, Pat mentioned that most people were able to stay dry 85% to 90% (or more) of the time upon faithful completion of pelvic floor therapy. The first week began with writing down everything I ate and drank as well as each trip to the toilet. The next assignment was to go to the toilet every hour in an attempt to stay dry. I was shocked to realize that I often couldn't even go one hour without leaking and I found it humorous how hard it was to pee every hour. Days at the pool were the most challenging. My eldest swims but not well enough to leave alone in a pool and of course I couldn't leave my three or one year old alone. So our daily routine went something like this. "Ok (for the fourth hour in a row) everyone, out of the pool (grumble, grumble, grumble, why mommy), mom has to pee!" Writing down the times I peed was another roadblock. Do you know how hard it is to pack for a family of five at the pool? Adding my "Bladder Diary" to the bag with the suits and swimmies and lotions and shampoos and plates and snacks just did not happen. Somehow I made it through the week.
At my second appointment, I was hooked up to a computer that measured how strong my kegels were, determined the extent to which I was relaxing between kegels and made sure I was using the appropriate muscles. I learned that while I kegeled well under the watchful eyes of Pat, at home I was not adequately relaxing between kegels. I was so focused on getting my kegels in that I was contracting beautifully, but not fully relaxing. Remember, biofeedback works! A hand on the belly reminds you to relax.
I also watched a movie on the amazing pelvic floor. Did you know that the urge to pee lasts 14 seconds and instead of rushing to the bathroom when you feel the urge (this makes you leak) you should first take a breath and kegel? Pat sent me home with new homework, pee every hour and a half and add pelvic floor exercises, three sets, contract for 8 seconds, relax for eight seconds.
Visit three, PROGRESS! The pelvic floor exercises were working! I was able to stay dry peeing every hour and a half and during a conference where I just couldn't slip out to pee, I found myself doing extra kegels and staying dry for about two hours! I noticed a few leaks that occurred when I had my morning latte and Pat suggested that I switch to half-caff (a painful switch but I am adjusting and you bet I will NOT be drinking half-caff at a birth.) I was hooked up to the computer again and the program detected that I had greatly increased the strength of my kegels in just one week! More homework. Pee every two hours and kegel four times a day, contract 10 seconds, relax ten seconds.
Week four. I forgot my sensor today and so I am scheduled for a final session in one month (probably a good thing as I will not slack on my kegels). The good news, when I kegel regularly (and appropriately!) I no longer leak! I will need to kegel for the rest of my life, and regularly (at least one set four times a day) but staying dry is worth the effort. And there are other benefits too! Developing strong pelvic floor muscles helps alleviate constipation and leads to better sex (among other things). If you are kegeling and it isn't working, I HIGHLY recommend visiting a physical therapist who specializes in pelvic floors. They will make sure you are kegeling properly, offer advice on how to kegel more effectively, and suggest things in your diet (like caffeine) that might be adding to the problem.
A disclaimer, I made a dramatic improvement in a short amount of time (four visits over the course of less than two months). This is because I had rather strong pelvic floor muscles at the start. It can take several months to see improvement and you have to be very diligent about doing your homework. If I don't kegel regularly, I leak, it is as simple as that.
I would love to see all midwives talk about the correct way to kegel (equal emphasis on relaxing as well as contracting) with their clients prenatally and post-partum. My gut feeling is that there are a lot of women out there who are incontinent and don't realize that a physical therapist can help you learn how to stay dry. I am a convert! Check out these websites to find a great pelvic floor therapist: https://hermanwallace.com/practitioner-directory, http://www.womenshealthapta.org/pt-locator/.
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