What Can Our Pelvic Floor Teach us About Motherhood?
The art of squeezing hard and letting go.
This week is about pelvic floor dysfunction—and how our deepest core muscles inform our whole health.
My newsletter is below. Strengthening our “core” is about more than a flat tummy!
For this week’s Q&A, I welcome your questions about pelvic floor issues. From urinary incontinence and uterine prolapse to hip and low back pain, submit your questions here.
Today’s podcast is an interview with NYT Opinion writer Jessica Grose about her new book, Screaming on the Inside: the Unsustainability of American Motherhood. Listen here!
Join me for our next Zoom hangout on Wednesday, June 14 at 8:30 pm ET! We will discuss recent newsletter topics such as breast cancer guidance, meds for anxiety, and whatever else is on your mind. You can register here! This is for paid subscribers only.
Health is about having awareness of the facts, acceptance of the things we can't control, and agency over our life.
Motherhood is about holding our kids tight and gradually relinquishing control. Can we hope for more control of our bladders than we have of our children?
I recently saw a patient—a middle aged mother of two—who reported urinary urgency and frequency, almost as if she had a constant urinary tract infection. She sheepishly admitted having to duck into the bushes to pee when she went for a jog. She was worried that something was seriously wrong.
Do you think I have a UTI? Maybe it’s diabetes? she asked me.
Her physical exam was notable for pale, atrophic vaginal tissue and weak pelvic floor muscles. Her blood and urine tests were normal. I reassured my patient that she is not alone. Women come into my office all the time with symptoms—from low back and hip pain to urinary incontinence—that stem from a weak pelvic floor.
Nothing says motherhood like urine running down your leg when you least expect it.
For many of us whose pelvic floor muscles were shot to hell during pregnancy and childbirth, being a mother is about wetting your pants when you sneeze, laugh or jump. It’s about standing at your front door and fiddling with your house keys, praying you make it to the bathroom on time. It’s about organizing your road trip around the location of rest stops along the way.
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It turns out that strengthening our “core” isn’t just about having a flat tummy; it’s about building back strength in our deep pelvic muscles. It involves more than sit-ups and planks; it requires attention to our pelvic floor muscles that hold our bladder, bowel, uterus and vagina in place.
The ability to appropriately squeeze and relax our pelvic floor muscles helps us move waste from our body. Pelvic floor muscles coordinate with the urethra, the tube that carries urine out of the body, and the anus, the organ where stools pass. Squeezing our pelvic muscles narrows these passages so that waste material can’t escape. Relaxing these muscles widens these passages so that we can pee or poop.
A strong pelvic floor is also critical for exercise. When we lunge for a tennis ball, for example, our pelvic floor muscles work in conjunction with our glutes, hip flexors, and quadriceps to stabilize our pelvis and maintain proper alignment. I commonly see women with chronic hip pain who aren’t getting better in traditional PT—and it’s only when they work on their pelvic floor muscles that the hip joint starts to work as it should.
My advice to my patient?
Awareness of the data
Approximately 1 in 3 women experience pelvic floor dysfunction (PFD) in the form of urinary or fecal incontinence, pelvic pain, and/or pelvic organ prolapse.
Numerous studies show that approximately one-third of all women experience urinary incontinence after pregnancy and childbirth.
Pelvic floor weakness can be caused by pregnancy and childbirth but also can occur in women who have never been pregnant.
Pelvic floor physical therapy has been shown to improve female urinary incontinence.
Menopausal women tend to experience more PFD than their pre-menopausal counterparts.
Local estrogen therapy (i.e. vaginal estrogen) seems to improve lower urinary tract symptoms such as frequency, urgency and urinary incontinence in postmenopausal women, however the effectiveness of systemic hormone therapy is not entirely clear.
Acceptance
To accept that pelvic floor muscles become weaker if we don’t consciously work them out.
To accept that time and patience are not usually sufficient to treat pelvic floor dysfunction.
Agency
To retrain and strengthen her pelvic floor muscles like she would any other muscle group on the fritz.
To consider starting vaginal estrogen to give her tissues enough strength to rehabilitate.
To try the five exercises in this video here—or the six exercises in a recent New York Times article here, recognizing that there is no substitute for in-person, one-on-one physical therapy to address our particular pelvic floor problems.
To consider using a set of vaginal weights to strength up her pelvic floor muscles.
To laugh about the humiliation of being a mom and the ridiculous things mothers put up with in order to have kids. My podcast from last week with Big Time Adulting’s Caitlin Murray is all about this!
Kids grow up, and we have to let them go. But we don’t have to relinquish control over our bodies.
What are YOU doing to tighten up your pelvis? Drop me a line below!
This week on the pod!
Why are expectations about being a woman—specifically a mother—so unrealistic?
Mother, author, and New York Times opinion writer Jessica Grose has a lot to say on this subject. Her latest book, Screaming on the Inside: The Unsustainability of American Motherhood, is inspired by her own shortcomings as a mother.
In honor of Mother’s Day, Jessica and I sit down to discuss the narrative and messaging to parents that “they’re doing it wrong.” Jessica urges parents to learn to trust their instincts and to show up to parenting as their authentic, imperfect selves.
If you like my writing, feel free to click the ❤️ or 🔄 button on this post so more people can discover it on Substack 🙏
Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
I am a healthy 78 year old mother of 2 with mild urinary incontinance, particularly when my bladder is fairly full and I cough. My MD, who is a DPC physician, has suggested 2 different approaches. Either the Emsella Chair, or pelvic PT. Insurance would pay for the PT but not the Emsella (a starting fee of $1000.) The PT is a few towns away and the Emsella is down the street. What do you think is the better choice for the long run? Any advice on how to make a wise decision?
I’m on long-term treatment for metastatic estrogen+ breast cancer. I’ve always thought vaginal estrogen therapy was contraindicated. But I have significant vago al atrophy and get frequent symptoms of UTI (not always positive for UTI). What is the best thinking on this issue?