I Can’t Hold in My Pee…

And other expert answers to your pressing pelvic floor questions.

You’ve got a lot on your mind during pregnancy. Your pelvic floor is usually not one of those things. But listen, it’s working hard! That little trampoline-like muscle that stretches from your pubic bone to the base of your spine has a heavy load to carry (oh hey, growing baby). It’s no wonder that during pregnancy and postpartum, you’ll notice some changes in “that” area, from incontinence to bowel dysfunction to pelvic pain and more.

Still, there’s this weird shame associated with talking about your issues down there, even though more than half of pregnant gals have some incontinence during their 9-month journey, and one-third of us experience poor bladder control postpartum. We asked our friend Lindsey Vestal, owner of the “mommy” occupational therapy practice The Functional Pelvis, to answer some of our most embarrassing pelvic floor questions. Don’t worry, nobody’s looking.

After having my baby, I often can’t hold my pee, and a little drips out. Is there anything I can do right away to prevent this from happening again?

Absolutely! Thanks for asking this sometimes embarrassing question. It’s a lot more common than you think; up to 70% of women leak urine either while pregnant or after they have their baby. It’s important to get reconnected to your core and pelvic floor. Kegels (or tightening the pelvic floor) is a place to start but there are other important things to do as well. The lower abs (the part you may squeeze in when fitting into a tight pair of jeans) share the same connective tissue with the pelvic floor. If you aren’t sure if you are correctly identifying your pelvic floor, focus on your lower abs. Engage them before you laugh, cough, or sneeze. Squeeze them as you lift up your baby. Not only will you be reconnecting to this important part of your body, but you will be protecting your low back as well.

I’m pregnant and everyone keeps telling me to do my Kegels. How often should I do them?

Kegels are very important in helping maintain the strength of the pelvic floor…but, believe it or not, for pregnant women we should talk about reverse Kegels! It is the ability to relax your muscles that will help during delivery. And don’t we all want help during delivery?! A reverse Kegel (called “down training”) trains your muscles to relax and your pelvic floor to open. I work with my pregnancy clients to achieve an optimal reverse Kegel by using Biofeedback so they get the instant visual recognition of what it feels like for their muscles to relax. It is truly incredible how much practicing revere Kegels will help during labor and delivery. And no worries, reverse Kegeling will not cause accidents.

Will my vagina return to normal size after I have my baby?

The vagina is an amazing muscle! That’s right, it’s a muscle. This means that it can be reconditioned after you give birth. Just like when you work out any other muscle in your body, the vagina can be toned and tightened… let’s call it the vagina boot camp! Kegels are one part of this… but focusing on your postural muscles such as the middle and low back, the inner and out thighs and the lower abs (the ones responsible for true core stability) will help as well. These muscles share a connection with your vaginal muscles and will help you tone from the outside in!

My girlfriend said she saw a Pelvic Floor Therapist during her pregnancy. What do they do?

A pelvic floor therapist is an Occupational or Physical Therapist that has received specialized training to work on the lower core muscles that go from the front, back, and sides of your pelvis and all the way to your tailbone. Similar to rehabilitation for an injured shoulder, structured therapy exists for your pelvic floor muscles. This muscle group is easily weakened for a variety of reasons. This therapy is commonly available in other countries where the stress on a woman’s body during delivery is recognized. In fact, in France, postpartum women receive an automatic referral to a pelvic floor therapist! The Functional Pelvis, a pelvic floor dedicated practice, provides in-home, concierge therapy for pre-and post-natal women. We manage all the muscular changes the pelvic floor goes through when pregnant, commonly rehabbing hip/low back pain, identifying proper mechanics to deal with pubic synthesis dysfunction, C-Section recovery, bowel and bladder health, and more.

Sex has gotten painful since having a baby. Could that be something related to my pelvic floor?

For women who tore their pelvic floor when they gave birth, the area that most likely tore is the spot where the muscles and nerves connect. As the area heals, scar tissue forms as a way for the area to be reinforced again. Scar tissue is often tight and would benefit from gentle massage to reintroduce pliability again. Some of the nerves in this same area may have also been damaged. Massage and reconnecting with how the muscles move (they move both upward (think Kegels) and downward (reverse Kegel) will help tremendously with getting normal, pleasurable sensations back.

For those women who didn’t tear and are still experiencing painful intercourse, the same area in the vagina was stretched considerably during the 9 months of pregnancy and could also benefit from similar techniques to get the muscles and nerves healthy again.

Do you have a question about your pelvic floor that you would like Lindsey to answer? Send them to [email protected] They will remain anonymous so feel free to ask your most taboo question!

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