I’m 22 months postpartum with my first child (can I even say I’m postpartum anymore?). But there’s one part of me that still feels like I gave birth just yesterday, and that’s my pelvic floor.
I knew that my body would go through a lot of changes during pregnancy and the child birthing process, but it’s clear from my inner new mom circle that pelvic floor health is wildly misunderstood and not talked about enough. Often as a new mom, you don’t realize you have pelvic floor issues until you cough, sneeze, or try to do high-impact exercises without urinating, so there’s often a sense of embarrassment and taboo that’s associated with admitting you have a weakened pelvic floor. But especially as we approach World Health Day on April 7, it’s time to speak louder about postpartum care.
Let’s backtrack a little: What’s a pelvic floor, anyway? It’s basically your undercarriage — the “hammock” of muscles that’s attached to the bottom of your pelvis and supports all your organs. If you’ve given birth, your pelvic floor can be pretty traumatized depending on what happens during your delivery. In my case, pushing out a nine and a half pound baby in just 25 minutes meant my pelvic floor was wrecked.
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Yet, I didn’t think to start seeking ways to remedy that until about nine months later. Partly, it’s due to the way the United States as a whole largely ignores postpartum care: It typically ranks last when compared to other countries when it comes to maternal healthcare. For instance, in France, they have what’s called la rééducation périnéale, which translates to perineal rehab, and the cost of 10-20 sessions of physical pelvic floor therapy service is completely covered by the government and considered the standard level of postpartum care. This government-subsidized program has been in place in France since 1985. Stateside, the notion of something like that for new moms is completely unheard of.
And, by the way, pelvic floor weakness is not just a problem that is limited to people who have given birth, too: Nearly half of women over 50 say they sometimes leak urine, according to studies. Pelvic floor training not only helps control urinary incontinence, but it also builds core strength and prevents the need for public organ prolapse surgery. Some women even claim it improves their sex life because you’re making the muscles stronger. So no matter what age you are — with or without kids — building a strong pelvic floor has its long-term benefits.
If you’re postpartum, once you get the green light from your OB (this happens around six to eight weeks after giving birth) to resume physical activity like exercise and sex, you can reach out to a physical therapist to do an assessment. ‘Knowledge is power and having even just one pelvic floor assessment with a pelvic floor physical therapist can provide you with an incredible amount of information regarding your pelvic floor muscles. Knowing where your pelvic floor’s baseline is (hyper-tonic, over toned or tight hypo-tonic, undertoned, or weak) can help you better address the dysfunction allowing you better results and ultimately leading to no leaking/peeing during any type of activities’, says Brooke Cates, the founder and CEO of The Bloom Method, a pre and postnatal fitness method.
Just like other muscles of your body, they’ll check to see if your pelvic muscles are able to contract and relax properly. If they find you’re indeed experiencing pelvic floor weakness, they’ll mostly work on gentle, low-impact exercises to build up your core strength and do a variety of stretches on your body (my favorite part of the day) to relieve any pelvic floor pain. This was pretty successful for me until the pandemic hit and I understandably no longer felt comfortable with my in-person sessions. But without the guidance, it was hard to find the motivation to keep working on my pelvic floor exercises and even harder to figure out if I was doing them correctly on my own.
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The most popular method of building up pelvic floor strength is by practicing clench-and-release Kegel exercises (named after gynecologist Arnold Kegel). You can identify those muscles by stopping your urine stream when you’re in the bathroom, or pretending like you’re trying to avoid passing gas. However, “Kegels can be a challenging exercise to get right. It can be difficult to find your pelvic floor muscles, isolate them, and exercise them correctly,” says Tania Boler, CEO and founder of Elvie. Like pilates or other exercises that work your core, proper form when doing Kegals is crucial — and unfortunately easy to screw up. “Over-kegeling or focusing on Kegels when your pelvic floor is already over-toned can simply lead to more injury or an increase in current symptoms. It’s vital that you not only know what your pelvic floor’s tendency is (hyper or hypotonic) but that you understand how the pelvic floor is supposed to move. Like all muscles, the pelvic floor should lengthen and contract — knowing this alone and practicing both phases of movement with your pelvic floor will lead to a more balanced and optimal pelvic floor connection while simultaneously addressing current pelvic floor issues”, says Cates.
Many women incorrectly push down on their pelvic floor while doing Kegels, which leads to incorrect contractions that can worsen the condition of your pelvic floor. It’s also easy to get frustrated with Kegels (“Uh, am I doing this right?”) and you have no way to monitor whether you’re really improving your strength. It’s like trying to train for a marathon without a timer.
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Also, you should also pay attention to your breath. Are you primarily a chest breather? “If so, there could be a massive disconnect throughout your inner core system (diaphragm, TVA, multifidus, and pelvic floor). This disconnect can lead to dysfunction that appears and can prohibit you from reaching specific goals in regard to the core and lead to injuries in both the core and pelvic floor. Reconnecting with your diaphragmatic breath can help to bring the inner core system “back online” and is the first step to addressing/fixing any injury-related symptom that you’re experiencing in the pelvic floor. While reassessing your breath might not seem as instant gratification as you might be seeking when wanting to address dysfunction, it is a critical piece that will lead to a newfound sense of core and pelvic floor connection’, explains Cates.
Especially without the help of a physical therapist at your side, one way to make sure you’re using the correct pelvic floor muscles is by using a device with biofeedback — this way you can become your own personal trainer. Enter: the Elvie Trainer.
Elvie Trainer ($199, elvie.com)
The Elvie kind of looks like a little mouse complete with a tail. It comes with a minimalist case where it houses the charger. Because of the material (medical-grade silicone) — and for sanitary purposes — you want to rinse it before and after every use. The whole device goes directly into your vagina, which admittedly seems intimidating at first, but essentially it feels no different than using a tampon and inserts very easily thanks to the smooth silicone. The “tail” portion sticks out of your vagina, and that’s the part that connects to the Bluetooth on your phone’s Elvie Trainer app, so you need to keep your phone in hand.
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You can do the Kegel exercises standing up, but I felt the most comfortable laying down. Whatever position you choose, it’s recommended that you stick to that position moving forward to see the most accurate results. Then comes the exciting part: The different games on the app involve using the right contraction of muscles to be able to move a little gem on the screen. One exercise involves holding your pelvic floor contraction to keep the gem above a certain line; another game involved pulsing the gem with your contractions. You instantly see how your Kegels are doing in real-time, and the app even informs you if the Elvie detects that you’re doing them incorrectly (e.g. by pushing down). At the end of the series, which lasts about 10 minutes, it gives you a summary of things like your strength, speed, hold time, lift time, and pulsing results. If you have a competitive nature, it’s also fun to see if you can beat your last scores.
I was surprised how hard you had to work your pelvic floor to improve your strength — YouTube videos of Kegel exercises make it look much easier — and sometimes I felt the device popping out. I realized I felt much more comfortable and secure using the optional cover that came with the device.
It’s recommended to use the Elvie Trainer at least three times a week for at least four weeks to see the best results. But after just one or two weeks, I felt like I already had more bladder control and could verify with the app that my Kegels were improving. Finally, for the first time post-baby, thanks to this little tool I felt more like myself — proving self-care doesn’t always have to do with what you look like on the outside.
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