I am STILL rehabilitating my postpartum body. And it's been over three years. The reason my healing is taking so long has everything to do with how much I've put off my self-care, as well as a host of pelvic health issues I had before getting pregnant.
Those same pelvic health issues linger today, which include stage four endometriosis, ovarian cysts, and scars from surgeries of the pelvis. Before getting pregnant, my husband and I struggled with fertility. That meant a lot of medical poking and prodding of my vagina and cervix.
I hated all the medical intervention, and after years of it, my body started to resist. I had to coax my pelvic floor to relax every time I saw a speculum or transvaginal ultrasound wand. My physical therapist at Body Connect explained that I was in an "upregulated" state during those pelvic exams. Meaning my body was in "fight-or-flight" mode, which also meant that my pelvic floor was tensed up for "protection."
In fact, for the first years after giving birth, my pelvic floor was constantly clenched and tight. That meant those muscles were weak.
Imagine trying to strengthen your biceps. If they're perpetually contracted with elbows bent, you aren't able to do a bicep curl. Also, constantly holding that position is exhausting. To build that muscle by doing a bicep curl, you'd need to relax and extend to curl up right? Well, the same principle applies to the pelvic floor.
I paint this picture to show you not all pelvic floor issues are the same, so why do we all get the generic advice to do Kegels (if we get advice at all)? For the first year of seeing my pelvic PTs, they advised me against Kegels until I could actually relax those muscles and address my pelvic pain.
When “Good Enough” Turns into Complacency
I got comfortable with the progress I made over the year with pelvic PT. It was “good enough,” but not great. I let my busy schedule take over and l lost healing momentum. The result? Some of those pesky symptoms crept back into my life: urinary leakage, poor posture, pelvic pain, queefing!
It's no longer okay to feel "good enough." I want to thrive, not survive with this one body I have.
I miss jumping on a trampoline without leaking, doing inverted yoga poses without queefing, and running on pavement without feeling like my hips are going to give out.
So, I'm going back to basics, and making some shifts in my mindset about my birthing injuries.
I Would Rehabilitate My Injured Ankle, Why Not My Pelvic Floor?
When I was in college I sustained injuries from athletic competition: broken ankle, dislocated patella (knee cap), and rotator cuff issues in my right shoulder. I rehabbed the heck out of those injuries because I wanted to continue competing. As a varsity athlete, I also had at my disposal a sports medicine clinic with dedicated trainers, physical therapists, and doctors.
Every once in a while, those past injuries act up, but I know how to restrengthen them.
It dawned on me recently that I should view my pelvic floor injury from giving birth in a similar way: rehab the heck out of it, and do maintenance when it acts up!
Coming to this revelation took self-reflection. I resented the idea of perpetual maintenance of my pelvic floor. Why can't it just work? I also resisted viewing my experience giving birth as "traumatic" or that it injured me. Those words "injury" and "trauma" are so loaded, especially when it comes to the act of giving birth.
But, then I realized, I don't have to view giving birth as "either/or." Birthing my son was an intense, emotional, difficult, easy, magical, real, out-of-body, in-the-body experience. Regardless of what emotion I attach to the experience, the reality is that I did sustain a pelvic floor injury.
I pushed for seven hours and I tore, three degrees into my perineum.
Doing a little everyday goes a long way
My pelvic floor isn't perpetually tight and irritated anymore, so I can focus on building its strength. I'm also working on breathing mechanics, specifically, coordinating my transverse abdominis to contract with my pelvic floor when I exhale, and for those muscles to relax when I inhale.
I'm also working on posture and stretching out tight muscles or foam-rolling fascia (connective tissue) to help with alignment.
To jump start my progress, I've committed to doing one or two exercises from each category below, every day.
1. Spinal Alignment
Release with a ball or foam roller: psoas, quadratus lumborum, diaphragm, quads, hamstrings, glutes
Stretch: hamstring and pelvic relaxation poses (child's pose, happy baby)
2. Breathing Mechanics
Inhale: abdomen expands, rib expands
Exhale: abdominal contracts, pelvic floor contracts (gentle), transverse abdominis (TA) isolates (gently), little movement of chest
[NOTE: I do this sitting, lying down, standing, and during functional activity. This works towards duration-based activities like running. I do this 3-4 times and then I take a break, for about 3 cycles.]
3. TA Isolation
A. Reciprocal breathing (movement/action only occurs on exhalation; rest occurs on inhalation)
Hooklying (on my back with knees bent): clam shells, marching, heel slides, kicks
[NOTE: I focus on my core isolation and that the TA, pelvic floor, and spine are doing the bulk of the work.]
B. Non-reciprocal breathing (activity occurs regardless of the breath)
Hooklying: clam shells, marching, heel slides, kicks
Quadruped (on hands and knees with neutral spine): bird/dog, push-ups, lifting both knees, knee to elbow
[NOTE: My TA/pelvic floor/spinal stabilizers are contracted continually. When they start to get weak, I stop!]
4. Pelvic floor strengthening
30 daily: half are rapid contractions, the other half are for endurance
Contract and release (x15)
Contract, hold (5 secs), rest (7 secs) (x15)
[NOTE: When my pelvic PT examined my pelvic floor contractions, she told me that I was only contracting the top and bottom walls. She encouraged me to contract using my side walls too.]
5. Internal pelvic floor releases
There you have it. My daily routine to get restregnthen my pelvic floor and core. My ultimate goal? To feel strong and grounded in my body again.
Do you have a physical therapy or postpartum healing routine? What types of exercises do you do?
**Medical disclaimer: This post is provided as information and resource only. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.
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