Confession Time: My Personal Postnatal Rehab Story
💔The relationship counsellor who's marriage is falling apart.
💪The personal trainer who never gets time for their own workout.
I write this as a postpartum support professional who tells mums to get all the help they need, yet put it off for myself.
The mama mentor who teaches other mums to look after themselves, but put making an appointment for myself low on my priority list.
The exercise professional who tells women to see a pelvic floor physio six weeks after they birth their baby, yet waited until my baby was sixteen months old before visiting them myself.
To be honest, I'd known something wasn't right at my first doctor visit.
Six weeks after ejecting an overdue and sizeable baby from my body through my vagina, there was a stinging and pulling sensation when the GP did my pap smear, despite my request to use the small speculum.
I wasn't leaking though, hooray! I wore it like a badge of honour that I must’ve been superhuman at doing those kegels my midwife told me to do.
I could feel my strength dropped off a bit after a few seconds with each squeeze, but overall I could hold the contraction for ages, so decided that was ok.
Months passed without giving it much thought. I had been to a professional development course on post-birth rehab and healed my abdominal separation myself using evidence-based exercise approaches.
Sure, we had to go gently at the start when we had sex or that same burning pain kicked in, but once I warmed up it was rosy.
I had also been visiting the loo fairly frequently through the day, but put that down to my body "making up" for not getting up through the night.
I had ordained myself as a having a wealth of knowledge about women's health and had been talking clients through how to do pelvic floor exercises and use their core muscles in their workouts for years.
I had very few risk factors or life-impacting symptoms (no previous trauma that might make me sub-consciously keep it tightened, no everyday pelvic or pain etc.) and felt fine.
Plus it meant organising child care and paying for an appointment... I didn't really need a pelvic floor check, did I?
I finally chatted with a physio friend (@the_rehab_mama, bless her cotton socks, who has spoken at length publicly about her own rehab process) who bluntly reminded me that what I already knew from my professional training: the reason to see a pelvic floor physio post-birth is not just to address incontinence, but to check for uterine prolapse, where the uterus starts descending into the vagina instead of staying in its original place above it.
In its early stages a prolapse can have no symptoms but can worsen with loading, like higher intensity exercise, lifting children as they get heavier, or if you get a really bad or constant cough.
I wanted to start training a bit harder with my weights and restart running, and my toddler was getting pretty heavy. I didn’t like the idea of having a major prolapse because of my stubbornness.
Eventually I booked my post-birth pelvic floor physio appointment, the one that I tell all my clients they should get at 6 weeks post birth before I make their whole body post-birth rehab plan, just 14 months late.
Still I wasn't admitting to myself that I had stopped those kegels long ago because I felt something wasn't right.
And I definitely wasn't admitting that my pelvic floor had anything to do with my sex drive or sensation post-baby (“oh it's just the breastfeeding hormones”, “I'm too tired”, ten zillion other baby-related excuses...).
I had shied away from the opportunity to do a brilliant course on feminine sexuality without really knowing why, perhaps this was the reason?
The physio appointment was a lengthy series of intimate questions and an internal examination.
Lo and behold, I was told what I already knew - I have an over-active, yet under-strength pelvic floor.
It makes sense that under-active pelvic floor is a risk for incontinence and prolapse but surely overactive just means really strong, right?
Wrong. An overactive (hypertonic) pelvic floor puts you at just as much risk of pelvic floor dysfunction like incontinence as an underactive (hypotonic) one does.
It can also lead to constipation, painful sex and, because the clitoris and pelvic floor muscles work together, it can prevent you from orgasming by tightening your muscles as you approach climax.
So basically, instead of the pelvic floor muscles being like a bowl or basket in the base of the pelvis, mine are more flat like a plate.
This makes it more difficult to relax and stretch the muscles, hence the pap-smear speculum and sexy-time ouchies.
[Fun fact: Silicone-based lubes are better when breastfeeding, as water based ones are made next to useless by your hormonal profile. Who knew?].
It also means they're kind of stuck in an "on" position at like 5/10 strength, but they don't have the energy left to really kick in to 10/10 strength if tested.
This is a pretty common situation for female athletes with strong abs and women who’ve done lots of repetitive impact training - female triathletes and long-distance runners have really high rates of pelvic floor dysfunction.
I'm no elite athlete, but can you guess what some of my past sports of choice have been?
These exercises themselves weren’t the problem, but aside from visualisations for birth, I’d never taken the time to learn to relax my pelvic floor muscles fully.
I can teach you how to do hundreds of exercises and variations.
I can write training programs in four year periodised cycles for national level athletes.
I can prescribe interventions for ridiculously complex cases, like people with recent stroke on background of heart condition, type two diabetes, osteoporosis and double knee arthritis, yet I can’t relax my pelvic floor without paying super close attention to what I’m doing (and not doing, I suppose).
So, here I am, writing as an exercise and postpartum professional, sitting on my heat pack and doing muscle relaxation work, not strengthening, while my toddler climbs on the couch.
I am embarrassed that it took me so long to make the appointment, and like every exercise client I've ever had, feel unsure about my capacity to fit my twice daily corrective movement homework in to my day.
I am grateful that I had the lingering niggle in my head and educated friend to push me to go, before I started my new training regime and seriously injured the pelvic floor that will be responsible for holding my organs, wees and poos in for the rest of my life.
I will be more empathetic with the mums I work with and alongside now that I have stopped ignoring my own body’s “dysfunction” post-birth.
The long term gains will outweigh the short-term shame, but I must admit my ego has taken a hit.
Most women will find out when the damage is done and harder to reverse or manage, because unless you're a real badass mum like Constance Hall or Clementine Ford, pelvic floor function and what is and isn't normal isn’t really talked about.
Post-birth care is so heavily focussed on the baby that mum is largely ignored unless her uterus is prolapsing out of her vagina, or wetting herself six months post-birth (if she even knows that this is something that isn't normal to raise with her GP, and makes the plans to have an appointment, and is listened to and referred to the right professional).
Pelvic floor physio is quietly recommended to women by some midwives and doctors, but not loudly encouraged because there is no Medicare rebate specifically for this type of appointment. There is a petition doing the rounds to change that, but progress in women's health service recognition is slow, and in some respects going backwards not forwards in this country during COVID-19.
I hope my story will give a mum out there the courage to seek help if something just doesn’t feel right, or to have a check even if it feels okay.
Please reach out - the Continence Foundation of Australia has a national helpline staffed by specially trained professionals to guide you on everything pelvic floor and figure out which kind of professional (pelvic floor physio, continence nurse, gynaecologist etc.) is right for your situation.
Specialised pelvic floor physios do exist, and have extra training specifically in this area, so get Googling. The physio I saw estimated that a third of their clientele sought treatment due to pain during sex, not leakage.
Pick up the phone mama, whether six weeks or six months or sixteen years post-birth.
I know it's hard to do. I feel you SO MUCH. But please, do it anyway.
You and your body are worth it.😘
The image above is a picture of stubborn me and my happy snuggle bunny around the time I should've had that pelvic floor appointment... Hindsight is 20/20!
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