You Deserve to Feel Fine About Your Pelvic Floor
A special guest post from Claire Zulkey from Evil Witches.
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Today I’m continuing my summer series of highlighting some of my personal favorite newsletters that I think Double Shifters will love. If you are new to the Double Shift and want to dive into my work, check out some recent posts, "Emerging From the ‘Camel Mode’ of Parenting Self-Sacrifice," and “What Abortion Bans and Child Care Shortages Have in Common.” So today I want to share this post from Claire Zulkey, who writes the oh so funny and oh so real newsletter Evil Witches. Its tagline is, “for people who happen to be mothers,” and it takes that centering of mothers’ human identity first with equal parts thoughtful and irreverent content. Claire blends a lot of personal essays and reader comments for very fresh perspectives on parenting, and the Witches community is awesome and engaged. Like the Double Shift, it’s full of cool moms who aren’t out here pretending to do it all.
This Evil Witches post about pelvic floor issues (slightly condensed and shared with permission) is a blend of reader comments and a short interview with a pelvic floor physical therapist. I’ve never written extensively about pelvic floor issues and think it’s extremely important to talk about and normalize. In case you aren't sure what I'm talking about, the pelvic floor is a big ole sack of muscle that impacts all of the other muscles and organs in the pelvis, like the uterus, the bladder, the vagina, the rectum, and can have impact on your hips, abs, and back as well. It's important for people to know what pelvic floor problems are, how common they occur for people who’ve given birth and how they are very treatable. I didn’t have any pelvic floor issues after the scheduled C-section birth of my first baby, and I erroneously thought that pelvic floor problems are only the result of vaginal birth. Boy was I wrong! After the planned c-section birth of my twins, who weighed over 6 pounds EACH, my back and pelvic floor were so completely screwed up I could barely walk around the block without a back brace, even though I never “pushed.” I got in with an incredibly experienced pelvic floor PT which helped so much. Another important takeaway of this post is that it’s never too late to get treatment. Even if your babies are no longer babies, you deserve to not have pain and incontinence. Without further ado, enjoy some Evil Witches, and sign up for that newsletter.
You Deserve to Feel Fine About Your Pelvic Floor
by Claire Zulkey
In my work as a freelance writer, I recently finished a project related to women’s health that re-affirmed that society/the medical establishment’s approach to women’s sexual health can be summed up with:
and of course
So, this email I got from a reader that was pre-emptively like “Do not wait to take care of yourself! You deserve to feel unbroken, at least in your pelvis, after having kids!” spoke to me. Here’s what she wrote:
Stress incontinence is not an inevitable stuck-with-for-life side effect of childbirth! And it is never too late to do something about it! My midwives (I’m in the UK) were adamant about this with both my kids. I have no issues at all 4 months after my 2nd. A runner friend who, two kids in, had incontinence and prolapse *and she is running again* with no worries. This after her physician said she’d always be leaky.
I’m not peddling any particular program or person (although I used Julie Baird’s on-demand program called ‘Mommy Body Bliss’ for those wondering. Bonus witch points for the fact that ‘a broomstick’ is usually on the equipment list.) But I think it’s important that people know they can hope for better! Rant over.
My kind of rant! I asked some other witches what seeing a pelvic floor specialist did for them. I hope it encourages you to do the same, or that you encourage someone else to who has been putting up with pain or discomfort or embarrassment that they don’t need to, whether or not they’ve given birth.
Witch 1: “I don’t pee that often when I sneeze, and I give all credit to my amazing magician PT. We had been working together before I got pregnant on some hip and back issues and have a great relationship. She was the first PT I’ve had (In a string of many) who acknowledged my body as being unique in proportion and having its own history (like all bodies!).
I was nervous about pregnancy due to some hypermobility and the existing hip stuff. She insisted on seeing me throughout my pregnancy and a few times after. I 100% credit her for how strong I was able to stay while pregnant and for my abs not shredding apart. Labor, pushing, and recovery went so smoothly, and I owe her a lot for that. She also helped me think about how to safely take care of a baby after labor and not have much access to my core muscles for a while.
I have a great memory of visiting her with my 2-month-old. He lost his shit and needed to breastfeed right at the beginning of the appointment. She was like ‘Cool! Feed him! And show me how you do it so I can help you not mess up your back.’
If any Witches have a PT they love and are planning a pregnancy, involve them! It was a game-changer for me. I should definitely add that I have an excellent benefits package and a workplace that allows me to make health a priority! This should be standard, but you know...’Merica.”
Witch 2: “I’m currently in pelvic floor PT for fecal incontinence. Very gross but the PT is very worth it! It was after the birth of my second. I was lucky because a friend who was pregnant before me had pelvic floor PT and really highly recommended it, and also made it clear that ‘Whoops, a little pee came out’ might be treated as normal postpartum but it absolutely does not have to be. Everyone should be able to hold their pee! And even more obviously, their poop!
For me, it immediately got about 30% better, and then with subsequent appointments it is getting better and better each time to where I’m like - 85% better? - after only five weeks. The hardest part is remembering to do my assigned exercise, but when I’m consistent, the improvement is HUGE!
I was most worried about asking for the referral, because it was embarrassing for one, and because I was worried the doctor would dismiss my symptoms as a normal part of postpartum healing. Luckily, they did not! I was talking to my PT about how essential her work is and how I wish it was just a standard part of care, and she said she has colleagues who work at women’s health clinics and just see people regularly as part of the workflow there. I wish I was at an OB like that!”
Witch 3: “I am a pelvic floor PT evangelist to mom friends! After my first spent 4.5 hours in the birth canal and I had a 4th-degree tear from forcep use, I had to go to PT if I wanted any chance at all to help control gas (a potential delivery impact that no one talks about! Also part of the pelvic floor!) There I learned that not only is pelvic floor PT about tightening certain muscles, it can also be about loosening them. In my case, I spent about 15 minutes a session with the therapist’s hand in my vaginal canal reducing tightness and asymmetry impacting my muscles. Really got over any modesty quickly. With my second, I hit up pelvic floor PT for diastasis, and I’m currently in the second trimester for my third (and last) pregnancy and am back in PT proactively.
Witch 4: “I did pelvic PT and it helped but it’s been more than 6 years and I need to go back because it’s getting worse again. There’s a great pelvic PT content maker on TikTok that I follow who did a post rounding up other PT TikTokers.”
Witch 5: “I sought pelvic floor therapy because after I gave birth it wasn’t just a matter of ‘I’m leaking a little when I cough or sneeze.’ I was full-on wetting my pants out of the blue all the time. I was either wearing adult diapers or putting those doggie pads on my bed. It was a combo of the pelvic floor muscle issues and also some nerve damage down there. I didn’t even have the sensation that I had to go. I also had diastasis recti. I had significant tearing too. I was a total mess.
I was wholly unprepared for what the recovery from childbirth would be, how much it sets everything out of balance. People don’t talk about it. The goal is to get the baby out, but I don’t think there’s much attention paid to the physical part of that fourth trimester period and beyond. We talk about postpartum depression, as we should, but I think it’s so embarrassing to be like ‘I am full on wetting my pants. I’m just sitting watching TV and I just totally wet my pants because I didn’t even know I had to use the bathroom because there’s so much nerve damage.’
I got a referral at my six-week checkup. I had to press for therapy. I was telling my OB all the issues I was having, and she was like ‘Welcome to motherhood.’ I said, ‘I’m very afraid right now that I’m going to be in diapers for the rest of my life.’ She took another look and said, ‘Yeah, at best you’ll get back to 60% of your vaginal tone that you had before.'
Don’t hesitate to go to PT. It’s not too late. The 2 PTs I worked with were very kind, very reassuring and very much validated the physical trauma of childbirth in a way that my OB certainly didn’t and no one else in my life had for me. It was treated like a fairly run-of-the-mill birth from a medical perspective but still traumatized me for me and having someone validate that trauma was important to me.”
Finally, after hearing from various witches about their regret they didn’t get PT sooner, their concern that it’s too late, their expectations that some peeing and leaving your kid at home for doctors' visits are both the norm, I ran a few questions by Dr. Shefali Christopher, an assistant professor and director of sports PT residency at Elon University in North Carolina, who specializes in helping postpartum athletes return to their sport safely.
Claire Zulkey: The takeaway I’m getting right now is that women accept a certain amount of incontinence in their lives and/or assume that pelvic PT is not for them.
Dr. Shefali Christopher: I see it a lot. I don’t think medical providers ask the question enough. It’s so under diagnosed. So many of us think it’s normal to leak a little after jumping or running after childbirth but it’s not. What PT therapists are trying to push is making it a normal question at checkups: “How much alcohol do you drink?” “Do you leak?” That should be part of the intake.
The second thing that’s a pet peeve of mine is that there’s a lot of information out there that you should “Do your Kegels,’’ but just like any other muscle, if you work it too much, there can be a problem of not relaxing it enough. If you’re holding a lot of stress and tension in your pelvic floor, you could be leaking because the muscle is fatigued and in that case the Kegel is not necessary. Deep breathing is what is needed.
Claire Zulkey: Something I hear a lot from friends is that they think they have separated abs (diastasis recti) and they don’t know if they should do something about it or not. It’s kind of wild that this is so common yet poorly understood.
Dr. Shefali Christopher: Are you having back pain, incontinence? Is there a reason why you’re worried to begin with? A few years ago, there was a lot of fear around diastasis recti and fear of movement. It’s basically as you go through pregnancy, the Rectus Abdominis, your six-pack muscles, tend to widen and the fascia in between widens. That’s not a problem unless there’s back pain or a hernia or excessive incontinence and leaking where the muscle is supposed to support you and it’s not doing its job.
It’s just part and parcel of pregnancy and recovery from it that some people have it, some people don’t. For the people getting surgery, it’s more aesthetic than actually functional. If someone is concerned, it is easy to go to pelvic help PT or a regular PT who has orthopedic knowledge of pregnancy and postpartum and they can try some different things to help with the back pain or whatever they’re having.
Claire Zulkey: How often do you see people who gave birth a long time ago and figure they missed their chance for pelvic floor rehab?
Dr. Shefali Christopher: You’re never too old. It’s never too far gone. You may look up and say “Oh crap, I should probably do something about this because I’ve been leaking for 10 years.” You can go and get the help you need. There’s no limit.
Claire Zulkey: What’s your policy towards patients bringing their kids to therapy?
Dr. Shefali Christopher: I personally love it. As a mom, I can pick up your child that’s crying and give her a pacifier and or bottle and continue what I was doing. We’re used to being able to multitask.
I would love, in a dream world, for your OB just to refer you for a PT evaluation and it’s up to you to decide how often you come, for how long. If transport/childcare is a barrier, then maybe you set up virtual appointments. That first appointment is important to tell the mom “Your health is important.”
We’re asking new moms about mental health, barely, asking about pain, then sending them off saying, “Come back next year.” The PT might connect three or four times postpartum, and sometimes they catch something like “You’re still bleeding? You shouldn’t be.”
There are so many things that can get better handled if there is this person checking in with the mom. The American Physical Therapy Association has an academy of pelvic health, and they’re lobbying on Capitol Hill that it becomes routine care.
Claire Zulkey: What do you say to people who are worried about having internal pelvic floor therapy?
Dr. Shefali Christopher: Only pelvic health providers have taken the internal courses, and you may not need an internal evaluation. It’s more personalized than the ob-gyn where they just lay you down, and they only need to use the index finger. The internal exam is looking at the strength of the contraction, the endurance, if there are any trigger points. Pain with sex, incontinence, pain with putting in a tampon are not normal and you should be talking to somebody about that.
PT providers are trained to deal with patients who have had trauma. They’d be OK with saying, “We don’t have to do internal work let’s try these external things.”
For this week’s members-only thread, we’re going to have pelvic floor free for all, so get excited and keep an eye on your inbox for that on Thursday. If you want to support this work and get members-only threads and other perks, become a member!
Big thanks to Claire for letting me share this great work. Check out & subscribe to Evil Witches! No newsletter or member thread next week. Stay cool, y’all.
Member Hangout: Kathryn Jezer-Morton on Camel Mode & More
July 25th 12pm EST
I’m super excited to share that Kathryn Jezer-Morton, writer of the Brooding column for The Cut, will be joining our July Double Shift member hangout! She is one of my favorite cultural commentators on family life, and she has a literal PhD in Internet momfluencers, studying what their rise says about the performance and commodification of motherhood. She's joining us for a lively Q & A where we’ll be discussing her column about the “camel mode” of parenting self-sacrifice, and so much more. And as an exciting new membership offering, I’ll be recording the conversation and releasing it in the members-only podcast feed if you miss the live convo. Members will get a zoom link and calendar invite directly to their inbox!