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.

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