Pregnancy is bathroom season. Lest I waddle too far from a toilet, I may wet myself. I knew pregnant uteruses weigh bladders down, but I thought my bladder would kind of bounce back to normal after pregnancy, like my abs were supposed to (ha!). I faithfully did my Kegels in Pilates and graduated from maternity clothes. But even as my body (mostly) found its pre-pregnancy shape, my bladder thought I was still pregnant.
My bladder got worse year after year following pregnancy. With all my activity, I believed I was healthy. Even with little infants, I kept a regular gym schedule. I’m a clean eater. I practice yoga. But I wasn’t healthy because I had to pee all the time. All. The. Time.
I was losing precious sleep as my bladder woke me up at least twice a night. I gave up watermelon. I stopped carbonated drinks. I limited coffee. One day I lost my entire bladder biking in Chicago, so I tossed my soiled cotton panties in the trash and let my quick-dry skort air dry as I pedaled and peed again, and again, and again. And again. That was the day I started the unhealthy practice of limiting water (which really didn’t help anyway).
There are lots of reasons women don’t get a pelvic exam. Mine was because I didn’t want to pee on the doctor. Our kids went to preschool together, our sons play soccer together, her husband is the coach. She sometimes attends my yoga class. I wasn’t sure if I could ever look my doctor in the face again if I peed on her as her attention was inside my vagina. I had trained myself to not pee with intercourse but I wasn’t trained to prevent leaking, or spraying, when the clear plastic speculum dilated to shine its little light onto my cervix. How was I strong enough to perform Olympic lifts and handstands, but not “strong enough” to perform an effective Kegel during a pelvic exam?
Kegels kept me dry with deadlifts and coitus but not with cycling or inserting a tampon. The hard truth is, while Kegels were constraining urine leakage, they were also constraining my ability to experience sexual pleasure — I was squeezing too aggressively. What would start out as a fun night in the sack often ended with my tears and confusion as I was unable to achieve orgasm with my oh-so-willing to do whatever husband. Should I pee on him or have an orgasm? Ughh. I couldn’t just let it go. He didn’t care about getting peed on, but I cared about peeing on him. I also cared about our mattress and floor, and there weren’t enough towels if I lost it like on the bike in Chicago.
I made another doctor’s appointment and saw the nurse practitioner in case I peed during the pelvic exam (I don’t have to see her at the soccer field). I asked to be referred to a pelvic floor rehabilitation specialist and I drove 40 miles each way to the closest one. I’m proud to share that after twelve weeks of physical therapy, and faithfully doing my home exercise program, my urge to pee has been reduced to only five times a day now. I don’t leak with biking or jumping, or sex. And more, I regularly sleep through each night without peeing. And yes!—I have regained the ability to orgasm without urinating again. Woohoo!
We moms aren’t exactly all smiles in the “fourth trimester” as our hormones are bungee-jumping off an emotional cliff and our crotch or abdomen is healing. Never mind our body forgot what REM sleep or skinny jeans feel like. We focus on baby’s growth and development and rejoice if we can get eight hours of sleep.
But we do not often realize, or are educated on, how our bladders and pelvic floor muscles — the muscles and nerves which support our bladders and vaginas — are injured during pregnancy. Pregnancy is basically a 38-week isometric contraction of pelvic floor muscles; they tirelessly work to keep baby inside. Pelvic floor muscles are contracted throughout pregnancy whether we are exercising or sleeping. Like moms with infants, they never get a break.
I eked out four full-term pregnancies, which means my pelvic floor muscles were contracted for three years in the 2000s. My pelvic floor injuries were a muscle contraction and impulse control issue which started in pregnancy and slowly progressed over the years; the exercise was exacerbating my bladder problems. But pelvic floor injury can range anywhere from contraction to stretch injury, nerve damage, impulse control, scarring, or even prolapse—when the bladder or vagina fall out of place.
Pregnancy and childbirth is sacred work: we break our bodies and shed our blood for the renewal of life. While this is a natural process, many of us experience injury if we aren’t rehabilitated to use our pelvic floor muscles naturally afterwards. We moms deserve to heal. Being handed a pain prescription, granny diapers and a hospital bill, along with the token Kegel exercises, is not enough to heal women who make the sacrifice to protect, serve and deliver life.
Think about it, if a gal sprained her shoulder as she strains her pelvic floor muscles in pregnancy, she would be treated with greater care and attention. She would be in rehab to get her shoulder working normally. Whether a woman delivers vaginally or via C-section, the process of giving birth is an assault to her body. We are told our bodies know what to do, and they do, but believing they naturally heal to normal functioning is often not true. If you don’t believe me, go look at the adult diaper section at your local drugstore and tell me why so many mommies need potty training.
The good news is that mommy can be potty-trained. I love seeing patients but I hate being one, especially one who had to learn to close my urethra with more coordination among other things. I am a licensed occupational therapist and after I went through pelvic floor rehab as a patient, I decided to become certified in women’s rehabilitation and open a private practice. In training, I learned that 65% of active women experience a high urge impulse to urinate; and up to 80% of female athletes experience some sort of incontinence. This means there are a lot of “healthy” women out there unable to control their urination urge or leakage. I also learned that 50% of women over 50 experience urinary leakage. Just think how much shorter the lines at women’s restrooms would be if we rehabilitated women after pregnancy!
Bringing forth new life through pregnancy and delivery is a labor beyond words. To smile and pretend we bounce back naturally is unnatural and ultimately unhealthy. It doesn’t matter if you were pregnant last week, last decade, or a few decades ago. If you pee more than five times a day or leak urine, go talk with your doctor (it’s okay if you pee on her, as long as you don’t have to see her regularly at the soccer field) and ask to be referred to a pelvic floor rehabilitation specialist. 97% of women report positive outcomes or cure with pelvic floor therapy.
If you are pregnant or planning to become pregnant, talk with your doctor about seeing a pelvic floor therapist now. The muscles and nerves which support your swelling baby bump will thank you. Be good to them so they don’t rebel as mine did, or give up like others.