Cough, Cough:: The things we don't talk about :: Adventures in Pelvic PT


I’ve recently had a new experience. It’s one I’ve been recommending to my female friends and clients for a very long time, and yet had been putting off, making excuses and avoiding for almost nine years.

I went to a pelvic physical therapist.

For several months this winter, I had bronchitis. And my strong coughing was causing me to pee my pants. Yep, I know it’s totally TMI! I said we don’t talk about them and we DON’T, except that we DO. Women joke about coughing, sneezing, jumping, laughing, and other things that we cannot do too hard after we’ve had babies or after a certain age—all of the time! And each time I hear one of these ‘jokes’, I either think, or actually say, depending on my level of friendship with the joker, that there IS help for that.

But, alas, the shoemaker’s children go barefoot and the doula is coughing and peeing. Until now. Well, actually I’m still doing it a bit, but I feel more conscious of what is happening down there. You may be thinking--”Oh yeah, I know all about Kegeling.” But in truth, strengthening the pelvic floor muscles is not always what’s needed. Indeed, that wasn’t the whole story for me.

The pelvic physical therapist that I visited today has a beautiful and very detailed model of the pelvis, with all of the organs and musculature—much fancier than those I’ve seen in birth classes. I sort of geeked out on how cool it was as she explained something that I know already, but was interested and happy to have a refresher in: the collection of muscles that make up the pelvic floor are totally amazing.

She also reminded me about these things:

•They are muscles.

•They can be both too tight (hold tension) and too weak.

•They can be strengthened.

•The can be coaxed into letting go of their tension

•They tire from overuse.

•They are connected to many other parts of our body including our jaws, our back muscles, our buttocks, and more.

•There are muscles that work both consciously and unconsciously

*We can bring more consciousness to how we are using them.

the pelvic bowl image used with permission from  Monica Aisaa Martinez

the pelvic bowl image used with permission from Monica Aisaa Martinez

What else did she do besides show me her beautiful pelvic model? In this practice, pelvic physical therapy includes internal examination and massage type techniques. Yes, this means that, with my consent, and with conscious sensitivity, the therapist was feeling around inside of my vagina. What this also means is that for those women that have experienced trauma, pelvic physical therapy can be triggering and difficult.

I’ve birthed five children vaginally. One might say ‘of course’ to my coughing issues, that they’re inevitable. And while it’s true, that trauma to the pelvic floor is often part of pregnancy and birth, they are but two of the contributing factors to the health of this area. I’m feeling re-inspired to broadcast the message that it doesn’t have to stay that way. There is help, not only for incontinence, but for so many other issues that women have with their pelvic floors and pelvic bowls.

Isn’t ‘pelvic bowl’ a lovely turn of phrase? It’s poetic and beautiful and feels nurturing—perhaps because it is where we are all first nurtured. I first heard it when I became familiar with the work of Tami Lynn Kent. Tami is a physical therapist whose life’s work is holistic women’s healthcare, and she is even referred to as ‘The Vagina Whisperer’. She is also an author, and her book Wild Feminine dives deep into the work of healing all kinds of trauma to this space—and its relation to our creativity and vibrancy. It is at the very top of the stack of books that are on my list to read this year. I have committed to reading it with a friend, because it is filled with exercises, meditations and practices to explore more fully these connections. I know I’m going to need some accountability for this work—after all, it took me nine years to make this first step. And, depending on how my experience with my PT goes, I may also visit a holistic pelvic care practitioner, maybe even Tami herself, as I’m fortunate enough to live in the same area. But she has also trained many practitioners to do this work.

I know this work needs to be done, and I’m writing about these things that we don’t talk about because enough of my friends, and even rather casual acquaintances, have mentioned to me that they experience some of the issues that could possibly be helped with either holistic pelvic care, pelvic physical therapy, or both.

I’m no vagina whisperer, but I’m someone with whom people share these things—perhaps because I’m a birth worker, so I must not be squeamish about yonis. And I’m not. But, it does trouble me to think so many of my sisters out there are resigned to the fact that things, BIG THINGS, are just going to be the same forever.  I have even heard from partners that the women in their lives are suffering and that their relationships are strained because of these unmentionables.


So, let’s talk about it! What are some reasons why one might visit a pelvic physical therapist or holistic pelvic care provider?

•Incontinence—even a little bit--yeah that jumping on the trampoline or jumping jacks kind, that too.

•Bladder or bowel issues

•Pain during or after sex, or inability to have penetrative sex

•Inability to use tampons without pain

•Pain in the vulva or skin conditions of the genitals

•Back pain or other pain involving the areas surrounding the pelvic bowl—hips, groin, abs

•Postpartum pain or numbness

•Scar tissue pain from tearing, episiotomy or cesarean birth


•Diastasis Recti or separation of the abdominal muscles

•Prenatally to assess alignment in pelvic bowl

These are just some of the physiological reasons that a visit to one of these practitioners would be helpful. There are also emotional and energetic reasons. Talking to your primary care provider can help you to get a referral to a specialist. A pelvic physical therapist who specializes in women’s health and who does internal techniques will be able to more fully address many of the above mentioned and other problems. As with any care provider, it’s important to find a good fit, so interviewing several and knowing your options is valuable, as well as knowing if they treat your particular condition. And because this is an area where we tend to hold a lot of emotional trauma and shame, it’s especially important to be comfortable.

If you are interested in Tami Kent’s work I highly recommend her Ted X talk:

And her books: Wild Feminine. Wild Creative, and Mothering from Your Center are all wonderful resources for exploring more about our pelvic bowls and beyond.

Will YOU talk about it? You don’t have to go splashing it all over the internet like this, but can you talk to a friend first, and then perhaps consider talking to a practitioner? I hope so. And, if, like me, you happen to be the person with whom people DO share these things, please consider sharing this article.

Questions? Comments? Need a doula? Contact me:

The Ever-Widening Hug

I fell into attachment parenting like I've fallen into many of the things that would become my passions: by accident. 

I have no recollection of seeing anyone practicing it, save perhaps some photos in National Geographic magazines over the years.

But, having embarked on the grand adventure of BECOMING PARENTS TOGETHER with my Beloved, I proceeded to read everything I could find about parenting, and somehow, Jean Leidloff's book, The Continuum Concept found it's way to my hands. And then, Our Babies Ourselves, and, more mainstream, Dr. Sears The Baby Book. In each of these books, the authors talked about how babies are pretty much hardwired to be held and when they are, they are basically content. (I now know, from talking to many of my attachment parenting friends, that this may or may not actually be true.)

I bought myself a ring sling, and was delighted with the simplicity of the design. I also bought myself a stroller and wondered if I would ever use it.  (answer: hardly ever)

When my firstborn was born, my husband worked from home, so we were both around to hold and carry and nurse (well, I did that part) that baby as much as he wanted to be held and carried and nursed, which we found out, was most of the time. 

We learned how to put on a sling and adjust it very quickly and also how to take it off and transfer our wee babe to his moses basket without disturbing him. We were baby wearers!

He also slept in our bed. Our first anniversary gift to each other was a kingsize bed. (Best parenting investment ever.)

These practices were sometimes questioned by our well-meaning family and friends. But, we found our own way through the first days, weeks and months of new parenthood, and those attachment parenting folks seemed to be right. Our baby was basically happy with being held close and sleeping with us. He rarely cried, and when he did it was kind of quiet--just letting us know he needed something. 

His 'womb with a view' as I had heard slings called, and loved, was his safe place to explore the world. He came with me to my part time teaching assistant job. The kids loved him and adopted him as part of the class immediately. 

And of course, he rather rapidly grew out of it. My embrace had to expand to accommodate the crawling and then toddling versions of baby. I remember the first time he sat in a grocery cart at the store. He was fairly old, probably near a year, long past being able to sit up. I was in the produce section and I stepped a few feet away from my cart to grab a vegetable. And then my heart went Ka THUNK. My baby was THAT FAR away from me. It felt very weird. I remember stepping back, closer to the cart.

Of course, between that day at the grocery store and now, he has ventured beyond my arms reach--it would be pretty creepy if he had not. And each little milestone was a celebration, and an opportunity to practice letting go: first time he crawled, first steps from me to Dad, first time he went up stairs, first time he climbed on a play structure at a park, first time he slept by himself, first time he stayed over with someone else, first time he went on a plane, first time he drove away from me.

Fast Forward 17 years. Today, I received a letter inviting me to send pre-fab care packages to him as he experiences his freshman year at college. He will be going to college 3,068 miles from home.

I began when he was little, thinking about parenting as 'the ever-widening hug'. He is 6'2" now, and when I hug him, my head is under his chin. (oh yeah! first time he was taller than me!). He tolerates my hugs, but also things I'm sappy and silly when I squeeze for just a little bit more. It is tempting to not let my hug grow ever wider. Part of my mama heart wants to keep him here with me--let's face it, part of my mama heart wanted him to stay little and Pooh-bear like--to find that magic potion that makes children stay tiny-cute (although he was never very tiny, but always cute). 

But, I cannot. I definitely have never seen a mama with her 6'2" baby strapped to her body. And, I now know that all of that attachment didn't stunt his independence and curiosity. I must, again, widen my hug to accommodate a new THAT FAR. 

And you can bet it will not be accompanied by any pre-fab care packages. Upon touring the campuses last fall he said, "You're totally going to be THAT MOM that sends me stuff ALL THE TIME, aren't you?" Yes. Yes, my dear boy. I will, so you can still feel my hug from very, very far away.



gratitude for the day

Today marks 14 years since I became the mother of my second child, my first daughter. It is the first birthday we have spent apart. She is many hundreds of miles away at a ballet intensive. I will not see her tomorrow, or the next day, not until she is almost 14 years and one month old. It's hard to imagine that this might feel 'normal' one day. It reminds me of the quote by Elizabeth Stone, 

“Making the decision to have a child - it is momentous. It is to decide forever to have your heart go walking around outside your body. ”

There is a time, in the beginnings of our children's lives, that we count their age by days, and then weeks, months, and finally, years. In those precious first hours we cherish each breath and noise and sigh, we are addicted to our babies. We can stare at them for hours.

Only hours old here.

Only hours old here.

Today, I did not have my tall, elegant ballerina of a 14-year-old here with me. But, I woke up in a mood to relish every moment, and also was reminded by a dear friend, and self-care accountability partner, to stay in the gratitude. Another friend was coming into town, and my never-ready-for-guests home was messy and dirty. I recalled something one of my post-partum doulas recommended after my third child was born. Instead of a 'to-do' list, make a list of the things you have done. When you are in early newborn days, that looks a lot like "Woke up, nursed the baby, changed a diaper, stared at baby, snuck in a shower while baby slept, changed diaper, nursed baby, ate a piece of toast, fell asleep nursing baby, put a cabbage leaf on my breast, walked to the mailbox with baby in sling, changed diaper...." It's slow, it seems like those days of diapers and baby feeding will stretch out forever. 

Man-child when he was a new 'big' brother.

Man-child when he was a new 'big' brother.

These days, time zips by, and especially these summer days, and I barely notice my feet hitting the ground running before it's story time at bedtime for the youngest and I fall into bed and sleep ALL NIGHT LONG most nights, which, after having many babies, still seems sort of amazing. I don't necessarily stop to enjoy the moments, or stare at my offspring, because they're older now, and all but the 5-year-old think that's creepy. Yet, today, I remembered that lovely woman's suggestion. I took stock of what I'd done throughout the day, with deep gratitude.

The minutiae of my life is not important here. But, in the simple act of making my 'done' list, I realized how very much I have to be grateful for: clean water, clean clothes, a man-child spending his first day at college, healthy children who play well together despite their difference in age, my college roomie and her spouse visiting, ice-cream, music and pirates, goodnight kisses. Even in the mess and noise of it all, it's worth paying attention to the wonder of it all, too. Sometimes it's nice to return to counting my age as a mama in days, or even hours.