Nicole is paying attention to her pelvic floor

A couple of months ago, I started feeling a dull pressure on the left side of my body. Not my hip or knee or shoulder. No, I felt a weird pressure on the left side of my vaginal wall.

After a quick mind scan of what could be wrong with my body, a few ill-advised internet searches, and a reigning in of “jumping-ahead-of-myself fears”, I made an appointment with my doctor (GP) to make sure there wasn’t anything concerning going on.

As is common these days, my initial appointment was held virtually. My doctor went through typical questions and then confirmed I would have to come in for an internal exam. Thankfully, nothing concerning was noted. I mentioned that I had been doing my own internet searches (apologetically, as I feel I need to be when saying this to my doctor) and that it seemed that my discomfort may relate to my pelvic floor and maybe a pelvic physiotherapist would be a good next step. I was surprised when she agreed with me (this isn’t how those conversations typically go – eg, I’ve read about estrogen dominance and I seem to have some of those symptoms, what do you think? I don’t believe in that).

After some investigation, I made an appointment with a local pelvic floor physiotherapist. Again, the first appointment was virtual. I have heard other women talk about their experiences with pelvic floor physiotherapists. They were usually women who’ve had a baby or two. I had a pretty good idea what they do and wasn’t sure how effective a virtual assessment would be. But, the physio quickly put my mind at ease. She was extremely thorough. Between questions, watching me do certain stretches and movements in my living room (fully clothed – phew!) and answering my questions, I left the consultation confident that she understood what my issue was, and that she could easily provide some assistance. The session was ended by making an appointment for the following week – in person – and with homework for me – stretches – no nothing like that yet.

Like a lot of people I know who are very focused with their workouts, I am not so focused on my stretching. I know it’s bad, but I am mentally done after a run or other workout and give a half-assed nod to a few stretches. So the stretches she gave me as homework, were a good reminder to do these more often. And that was part of our conversation, that in addition to my specific issue that I was contacting her about, I wanted to know if there were maintenance things I could do, to prevent further issues with my pelvic floor. One cannot reach their late 40s without knowing that there may be issues with their pelvic floor in the years ahead.

The exercises she prescribed pre-in-person meeting were: quad stretches, runner’s lunge, seated clam shell stretch, seated one-leg hamstring stretches, the glute one where you are lying on your back and have your foot in front of the other folded leg and pulling your thigh towards you and then another one that is similar, but kind of like a “half-baby pose”. As the physio explained, these muscles are all connected to your pelvic floor. And, as any of us who’ve experienced a muscle injury knows, it’s rarely about the one muscle. Weakness in one, will typically lead to injury in another. In my case, I have no doubt, everything is connected to my tight hips and hamstrings.

On a relatively nice, sunny, February day, I walked to my physio appointment with my double mask and open mind. It probably helped that I had “met” the physio prior to this appointment that was about to become much more intimate. After asking me a few questions, she handed me the typical doctor’s office drape for the part of me that was about to be naked and I waited on the table until she returned for the exam.

This type of exam is never going to be completely comfortable, but she was very professional and had a confident manner that made me trust her. It wasn’t uncomfortable, from a pain perspective (I used to have painful Pap smears so it’s something I always prepare myself for in these situations), but I’m sure that can vary, depending on what the issue is. As she prodded and felt around and asked me to put my legs and feet in different positions, she explained what she was doing and why and what was likely the problem. She also started giving me my main homework. Reverse kegels.

We’ve all heard of regular kegels. Cate has written about tools for this purpose before on the blog. Many of us do them incorrectly. I have had other professionals explain to me how to do them. Not as “invasively”, but very specifically and it helped. This physio confirmed, with her hand in my vagina, that I was, in fact, doing them correctly. What I needed to learn how to do was “reverse kegels”. I was not a quick study in this regard.

With regular kegels, you essentially “zip up” your vagina, up as high as you can, to your navel, by strategically squeezing your vaginal muscles. With reverse kegels, I am to practice imagining that I am “opening my vagina”, at the same time that I am inhaling. These two things do not naturally go together. And, I am not naturally coordinated. It took me many tries and with her giving me different prompts – try with your mouth open, try in “baby pose”, when you practice at home, perhaps try in squat position – before she was satisfied with my efforts that I could practice on my own at home.

From a physiological perspective, the issue I am working on correcting or preventing from happening again, is my tight coccygeus muscle. The pelvic floor is a ‘sling’ of muscles, a bit like a small muscle hammock that runs between the pubic bone in the front, and the tailbone at the back. 

Armed with this new knowledge, I set about practicing the reverse kegels, along with the other stretches I was now doing daily. This was a few weeks ago and the pressure I was experiencing has greatly improved. I went back for a follow-up appointment, where she confirmed the muscle was less tight and practiced the reverse kegels with me again to make sure I was doing them right. I have a follow-up appointment scheduled for a few weeks from now, but she said if I’m still feeling better, I can go ahead and cancel it. It’s just a placeholder in case I need it. I appreciate that she is not asking me to come back for more follow-up appointments if they are not necessary.

Why am I telling you about this experience? Because I think there is room for women to share more of these experiences, so that we normalize pelvic floor health. It’s an important part of overall health, including ability to engage in regular exercise, as we age, and we should feel comfortable talking about it. Also, if you’ve been thinking about going to a pelvic floor physiotherapist and were nervous about it, don’t be! I recommend it.