The tissue paper crinkled as I scooted my butt to the end of the exam table. I placed my feet on the stirrups, which were adorned with frilly pink socks. I eased my swollen, postpartum body back and waited sleepily for the Gynecowboy to complete his exam. (My friend Kelly and I secretly called my ob-gyn the “Gynecowboy” due to his friendly Texas drawl and penchant for wearing cowboy boots with his scrubs.)
It was 2015, and I had recently given birth to my second baby. Having gone through birth and postpartum once before, I was intimately familiar with its ills: the doughy belly, the milk-swollen breasts, the sore privates, and the exhaustion. It’ll get better, I reminded myself. I’d get the “all clear,” and then go about momming while my body healed itself in the background.
Finally, the Gynecowboy peered up from between my legs, a serious look coming over his genial face.
“You are clear to resume your normal activities,” he said, peeling off his exam gloves. “But I’m going to write you a referral to pelvic floor therapy. I recommend it for many of my patients. This can happen, especially for moms who have bigger babies. Without it, you may experience some issues, like incontinence, possibly fecal…”
A jolt ran through me. Did he just say I might develop fecal incontinence?!
I didn’t hear anything the Gynecowboy said after that. The only time I had heard of “pelvic floor therapy” was at a doula meet-and-greet event I attended before the birth of my first son. The pre-show to the main event, a perky physical therapist stood before us, an anatomic model of female pelvic muscles in her hands. She cheerily described the ways that pregnancy and birth could wreak havoc on these alien inner muscles. I was aghast. But being a first-time mom-to-be, I was already deep into information overload and forgot about it shortly after. Until now.
I’m…damaged goods. The knowledge caused my cheeks to flush as I nodded meekly to the Gynecowboy. I stared at the gray, low pile carpet as I took my referral paper and shuffled next door to set up an appointment with the nurse.
At the first pelvic floor therapy appointment, I fidgeted in the waiting room. What exactly were we going to do? What would we talk about with my vulva exposed for half an hour? This is gonna be so awkward.
Hannah* greeted me warmly. She was a petite blond woman about my age. She explained what would happen in a very calm, soft manner that immediately brought my blood pressure down.
Every session would be similar. First, I’d undress from the waist down. Next, she would insert a wand in me, which would measure the strength of my Kegels and chart my progress in the program. Finally, she would assign an exercise “prescription” to practice in between sessions.
Turns out Hannah was a toddler mom like me, and we had plenty to talk about. We troubleshooted sleep issues and discussed where to find affordable children’s clothes while I squeeze-hold-released, squeeze-hold-released my PC muscles in rhythm around the wand.
I downloaded a Kegel timer app to my phone and did my exercises religiously in between sessions. The prospect of potentially crapping my pants at some future date was a great motivator. Hannah complimented my progress. I started worrying less about laughing, coughing, and sneezing (although a triple sneeze was still a death knell for my bladder.)
In six weeks, I was discharged from pelvic floor therapy. Hannah handed me my final exercise prescription.
“Congratulations,” she said, smiling.
“Thanks,” I replied, smiling back. “So I do this program for like, what, the next six months or so?”
Hannah blinked. “Oh, no. This is for the rest of your life.”
I was taken aback. The rest of my life? I shifted uncomfortably. I had dedicated myself the past six weeks to doing Kegels with the expectation that the issue would be resolved and I would be done, forever. The idea of having to keep it up for years never occurred to me. A wave of resentment washed over me.
I continued the exercises for another month or two. But eventually, life began its inevitable creep. And boy, did it creep.
Three things happened in the fall of 2016: I went back to work part-time, my oldest son was diagnosed with a neurodevelopmental disability, and Donald J. Trump was elected president. Within a matter of months, my life was upended. While trying to adjust to being a working mom of two, I found myself thrust into a byzantine maze of doctor visits, evaluations, paperwork, therapy appointments, and calls to my insurance company. Early intervention, before age five, was critical, the experts said. Knowing this made every decision feel high stakes, the difference between my son’s future success or not. To make matters worse, Trump and the Republicans threatened daily to overturn the Affordable Care Act, which would take away our health insurance and undo my efforts to secure help for my son.
I went into problem-solving mode, busying myself with research and action, the picture of competence. I was determined not to fail. But I felt I was anyway, the sideways glances from strangers as I tried to manage my child’s meltdowns an indictment on my parenting. Anxiety filled my days and grief seeped in during the quiet moments at night.
I was starting to crack under the pressure. I longed for my life before children and then shamed myself for it. The intrusive thoughts in my brain scared me. So I went to the Gynecowboy’s nurse practitioner and had my dosage of Zoloft upped. And then upped again.
I needed a change, a self-improvement, to help me regain some confidence. I decided to start by tackling the baby weight stubbornly clinging to my middle. I joined a gym and downloaded a beginner strength training program. With each sweat session, my body inched closer to feeling like mine again. I felt a glimmer of hope return.
About three months into the strength program, I was at the gym when I saw a new exercise pop up on my phone: ten minutes of a jump rope cardio “finisher.” But as soon as my feet hit the ground after the first jump, a warm, wet sensation gushed down the legs of my yoga pants. I froze as the realization dawned on me in horror.
It was pee.
I left the gym hurriedly, avoiding eye contact. I found a hand towel in my car and placed it on the seat as the scarlet humiliation rose up from my belly and bloomed across my face and chest. This, like everything else, was my fault. Hannah had told me I needed to keep up the Kegels, and I had failed. Typical.
It’s never ENOUGH. White hot rage coursed my veins as an invisible hand wrapped around my throat. My vision blurred with tears. I couldn’t control my life any more than I could control my bladder. A strangled sob escaped my mouth as I slammed my hands on the steering wheel, the taste of salt on my tongue.
At home later, I racked my brain for the name of the pelvic floor clinic from the doula meet-and-greet years ago. A quick Google search yielded the name. I called the Gynecowboy’s office and they promptly sent a referral.
At the first appointment with my new physical therapist, I undressed from the waist down and pulled the thin sheet over my cold, goose-pimpled hips. The prospect of making small talk with a stranger while she poked around my lady business didn’t feel that weird anymore.
“Are you comfortable?” Vanessa* asked kindly as she gloved up. I nodded silently.
As she chatted casually with me during the pelvic exam, I began to relax. Vanessa was humorous and easy to talk to. Before the end of the session, we were swapping horror stories about our first Brazilian waxes.
After that, Vanessa and I quickly fell into a comfortable rhythm during our sessions. No topic of conversation was off-limits. Vanessa asked me directly about peeing, pooping, and sex, normalizing everything I was experiencing. The shame began to lift.
As I sat in the crowded waiting room before each session, I observed the women (and one man) sitting on the faux leather chairs around me. I wondered about their stories, their unspoken fears. Were they like mine? Outwardly, we smiled and complimented each other’s shoes. We cooed over babies and joked around with the ladies at the front desk. Even though we never spoke directly about our issues, I knew my problems weren’t special. I began to think of us as a club. I was no longer alone—at least when it came to pelvic floor problems.
In session, Vanessa had me do so much more than just squeeze-hold-release. Sometimes, she would massage my core, thigh, and glute muscles; other times, she worked inside me to free the tension. Periodically she placed sensors along my perineum to chart the ability of my muscles to contract and relax. I practiced jumping in the safety of the room to test my progress. We ended each session on the floor with Therabands, Vanessa teaching me new exercises and stretches to practice at home.
With repetition, my body shifted. Weak tissue became stronger and more pliant. When I picked up dumbbells at the gym, my trunk felt solid. A tree able to bear its weight again.
I was not, as it turns out, damaged goods. I was simply a work in progress.
I felt some buoyancy return. Laughter came more easily. I giggled as Vanessa regaled me with stories about late nights out, her new boyfriend, and boozy all-day brunches without feeling the acute loss of that period in my own life. I made her laugh, too, which felt good. One day, I told her about the time I’d met a friend at a brewery with a pair of granny panties unknowingly bunched up in the leg of my skinny jeans. Vanessa belly laughed so loudly that I cracked up too, our laughter going silent, tears streaming out of our eyes. “Please, always come to our sessions with stories like that. Please,” she said when she caught her breath, dabbing her eyes with a tissue.
Some things didn’t change. My kid still had a diagnosis. I carried an overwhelming amount of responsibility between work and home. I continued taking a lot of Zoloft. Grief and anxiety lived rent-free in my gut.
But I was managing each day, albeit imperfectly. As my body healed with PFT, I had just a little more bandwidth to face things as they were. But it was enough.
Meanwhile, the Republicans gave up on trying to repeal the ACA. The work I had put in for my son’s care months ago was starting to come to fruition. And, after realizing how a sense of community at PFT helped me, I reached out to a disability organization and started talking to a mentor each week. The hand around my throat loosened its grip.
One day, I came home from PFT to the eager, adoring faces of my children. As I kissed the tops of their heads, I felt a swell of 100% pure, distilled love so great it bowled me over. As challenging as life was, it was also abundant. Maybe the challenges had even amplified the abundance.
Then, pelvic floor therapy was over. I could now jump without leaking. My body felt trustworthy again. But strangely, I felt a little sad.
“I feel like I need a punch card or something,” I told Vanessa. “Like, maybe I can get a free sandwich or something for finishing? It feels weird to just…leave.”
She nodded. “Maybe we can find you a balloon. Like, we can write, I finished pelvic floor therapy today on it.” She put on a wide, cheesy smile, and mimicked holding a balloon. We laughed and hugged goodbye.
But it didn’t end up being goodbye. I returned a few months later to PFT for bladder urgency issues, and then a few years later for rectal pain, another side effect of pelvic floor disorder. To my surprise, I was instructed not to do Kegels anymore, as they were causing unnecessary tension. I learned new exercises and lifestyle changes to help me adjust to the shifting realities of my body.
Today, I no longer do pelvic floor therapy. But as I continue to age, I think it’s likely that new issues related to pelvic floor dysfunction will crop up. At least I know what to do—and that I’m far from the only one dealing with this medical issue. According to a study published in JAMA (2008), almost one quarter of women experience symptoms of at least one pelvic floor disorder during their lifetime.
A few summers ago, I was at a neighbor’s barbecue. I began chatting with the young mom one street over. Her daughter, a new walker, toddled around us precariously. My neighbor had celebrated her daughter’s first birthday a few months before by running a marathon (slacker).
“I’m super impressed. That’s awesome! How was it, training after birth and everything?” I asked, sipping a LaCroix.
“Oh, it was hard. It was good, though,” she replied, handing her daughter a meltable wafer. “Although I noticed my shorts were kinda wet during the run. I was like, I hope this is sweat,” she said with a grimace.
I smiled. “Well, maybe it was. But if it wasn’t, I recommend pelvic floor therapy,” I said gently.
Welcome to the club, mama.
*name changed
Lynn Badgett is a writer based in Austin, TX. A former healthcare worker, she currently homeschools her oldest son. Her writing is focused on wellness, parenting, and midlife. In her free time, she enjoys singing in a women’s choir, meditating, and hanging out with her husband and two boys.
"Gynocowboy"! This has made my day. So good! I'm in the same club except for me the pelvic floor therapy wasn't enough and I ended up having pelvic sling surgery. Gave me my life back! I'm glad your writing about this because it affect countless women!