In the waiting room at pelvic floor rehab, I can't help staring at the other patients. They are mostly women. Some are elderly. Some, like me, hover around middle-age, and a sprinkling of the women are younger. For a moment, I feel awkward that the other women know why I'm here. The thought makes me Kegel almost involuntarily, as if my vagina had found itself in a competitive environment. The embarrassment settles as I remember everyone else is here for similar reasons as I am.
Those of us who find ourselves in pelvic floor rehab, however, are not alone: The National Institutes for Health report that nearly a quarter of women in the U.S. experience some form of pelvic floor dysfunction. Symptoms include urgency and frequency of peeing, incontinence, sexual dissatisfaction and more rarely, organ prolapse or fecal incontinence.
Ally appears in the waiting room and walks me back to her office. I showered and shaved this morning, as if primping for a hot date. This lady has seen more of me lately than my husband has.
"So how's it going?" she asks, as we both settle into chairs.
"Okay. I've been cutting down on my coffee and drinking more water like you suggested," I say. Drinking less coffee hasn't been as miserable as I thought it would be. I'm learning to savor that first cup of coffee in the morning, and I challenge myself to empty my 27-ounce water bottle before noon.
"So how much coffee are you drinking now?" she asks.
"About three to four cups." Before I started pelvic floor rehab, I'd been drinking four to six cups a day. With a 4-year-old and a toddler, it's still a rare evening when both kids sleep through the night.
"And you're drinking more water?" Ally inquires.
She explains that limiting water intake is not an effective way to cut down on peeing. "I've seen some older clients who will only drink one little glass of water a day, hoping that they won't have to go to the bathroom as much. They end up really dehydrated, and it doesn't help them have to urinate less," she says. She tells me how dehydration causes urine to become highly concentrated and acidic, which irritates the bladder and makes it spasm. The bladder spasms feel like the urge to pee. I had always thought I just had a small bladder; I had no idea that my bladder could be having a spasm, reproducing the feeling of the urge to pee. You are such a spaz, I tell my bladder mentally.
"So how often are you urinating?"
"Um... maybe every hour or so?" Cutting down on the coffee seemed to immediately space out my trips to the bathroom a smidge.
"And how's your incontinence been?" The word flashes neon shame in my mind: INCONTINENCE. Since having my children, I'd occasionally noticed a drop or two of moisture in my underwear. I comforted myself by thinking it was just a little "lady mist." Or at worst, a tiny bit of post-baby dribble. But surely not a full-blown, Defcon five, Depends situation.
Though there was that time a month ago, just before I started pelvic floor therapy. The kids and I were visiting my parents, and we were all plopped on the floor in their living room. With no warning, my 4-year-old yanked down his pants and taunted us all with his bare, peach-hued butt. "I'm going to poop all over Papa!" he announced.
I lunged for the bathroom, but I was laughing too hard. My bladder let go, and I shuffled the rest of the way to the bathroom, drenched in my own fluids. I left my parents' home that day donning my mom's silky panties, with my own wadded up in a plastic shopping bag: The walk of shame for the middle-aged crowd.
"Um... maybe a drop once or twice?" I say to Ally.
"So, maybe two episodes of incontinence a month?" Ally asks. I reluctantly agree.
"And you've been doing your Kegels?" she asks. Ally had assigned me two different patterns of Kegels to do several times a day. The first version was a series of two-second Kegels, with short rests in between. The next was for stamina, and was a five-second hold.
"Yep. I'm squeezing my taint all the time," I promise.
This is not entirely true.
Though Kegels can be done surreptitiously and while multi-tasking, I find it challenging to remember to incorporate them into my day. With two kids under 5, I find it's hard to maintain normal personal hygiene routines, like tooth brushing and showering, let alone this sort of high-level crotch workout. But I do them when I remember, which for some reason seems to be mostly at traffic lights and while I'm hunched over my daughter's crib at night, waiting for her to sink into sleep.
"So today, I'm going to work on loosening some of your muscles in your abdomen," Ally says. "Having tight muscles around your bladder can also cause it to spasm."
I have only one question: "Do I get to keep my clothes on?" I ask.
"You do!" she says in her lilting voice, her voice curving up like a smile. I beam.
I lie down on the table. There's no big pad on it this time, and I'm grateful for the small slice of dignity. Ally moves her fingertips around my belly. It tickles, and the pressure makes me want to pee, despite the fact that I stopped at the bathroom on my way into my appointment. I close my eyes and try to relax. It feels like a mini massage, except for the pressure on my bladder.
"Tight muscles in the inner thighs can also contribute to pelvic floor issues," Ally informs me. She begins massaging my inner thighs. Though her touch is completely professional, I can't help but imagine this scene as the intro to a low budget porn flick. It strikes me again how intimate this process is, and I feel proud of myself for making the leap to take better care of myself.
"Alright. Let's head out to the studio." Ally says. I snap back to the moment. "I'm going to have the therapist work on the Pelvic Brace with you today," she says.
Pelvic Brace? I panic for a moment. Is this something I'm going to have to wear, like a cod piece? Announcing to the entire world that my junk is all jacked up?
Ally notices my confusion. "The Pelvic Brace is where you tense your pelvic floor and your abdomen at the same time. It'll help strengthen your core. And you can do it when you lift things or cough, and it'll help prevent leakage."
Ally escorts me to the group therapy room and introduces me to Kate, a therapist who looks to be in her 20s. Each appointment consists of work with Ally or one of her colleagues in her private office, followed by half an hour of Pilates and body awareness work in the group therapy room. Kate wears leggings and a shirt that slips down her shoulder, Flashdance style. She greets me with a warm smile, and leads me to a corner table to school me on the Pelvic Brace. Lying down, it takes a few tries to coordinate my nether muscles with the area just below my belly button. It doesn't help that every time Kate says "Pelvic Brace," the lyrics from "Time Warp" from the Rocky Horror Picture Show blaze through my brain. Do the Pelvic Brace! Uh! Uh! Uh!
Kate leads me through a series of bridge poses. "Exhale and Pelvic Brace as you lift yourself up," she says calmly as I raise my hips. "Nice. Now take a full breath at the top, and exhale and Pelvic Brace as you return to the table." Her voice has the soothing rhythm of a yoga teacher. I lower myself. I've done the bridge pose in yoga a hundred times; it's one of my favorites, a heart opener. But with all the tensing and breathing, my brain threatens to explode.
When it's time to leave, Kate hands me a sheet with instructions on the Pelvic Brace. "You can practice this anytime you're lifting anything, or whenever you cough. It'll help strengthen your pelvic floor and abs," she says, smiling.
"Thanks, Kate." I head out, the alternate lyrics to the "Time Warp" still cruising through my head.
My appointment today is with Ally's colleague, Sam. She is a lithe, adorable little thing with a teensy tiny baby bump at just over four months pregnant. She has a clean, make-up free face and sparkling green eyes.
"So, Ally wants us to do some biofeedback today," Sam says, wheeling a laptop into her office. I know what this means: ass sensors.
"Oh, man!" I groan.
"I know, I know. It's no fun," she says sweetly. Somehow, the fact that Sam is pregnant makes me feel better about having to pull down my pants and underwear so she can stick those sensors on my butt.
"I asked Ally if she was hooking my ass up to her computer. She said, 'Pretty much.'" Sam giggles, passing my not-so-discreet sense of humor test.
"Yeah, when I tell my kid patients, I say, 'Guess where this is gonna go!'" For some reason, I had not considered that children would need pelvic floor rehab.
"What age of kids do you usually get?" I inquire, while Sam gently separates my butt cheeks.
"Usually they're between 5 and 8. I get a lot of teenagers, too. There!" she says. "You can pull your pants back up."
"That was quick! So, are most of your kid patients born with pelvic floor issues?" I ask, buttoning up. The thought of small children going through this process helps me suck up the indignity I'm enduring.
"A lot of them dealt with constipation issues early on, and got used to tensing up those muscles. When the pelvic floor muscles get too tight, that can cause problems with incontinence, too."
Sam has me sit up and do a series of 10-second Kegels while we watch the computer screen. She reminds me to breathe. When I exhale, my body inherently wants to let my vag go lax, but instead I am supposed to keep the muscles tensed. It feels completely counterintuitive, and I worry that either my brain or my vagina is going to combust. I briefly wonder what that would look like on the computer screen.
After several tries and reminders from Sam to breathe, we watch as my pelvic floor paints pretty little yellow mountains and valleys across the computer screen.
"Were you really good at staying inside the lines when you were a kid?" she asks.
I shake my head. "Not at all. But maybe if I'd been drawing with my vagina, I would've been," I say. Sam giggles, and I am both grateful and surprised by how comfortable I feel with her.
"Alright. Great job. Let's get those stickers off your bum," she says.
"Those are the sweetest words I've heard all day, Sam."
Stay tuned for Part Three!
This post originally appeared on the elephant journal.