One of my pregnant patients was asking me the other day about what your vagina is like after giving birth. I reassured her that the tissue of the vagina and the perineum usually comes together very easily after a delivery, even if she tore, and that the perineum usually heals beautifully after a birth (a midwife preceptor used to joke that if there are two pieces of a perineum in a room they will find each other and stick together, such is the beauty of it). However, I admitted that the muscles of the vagina are another story altogether, and that rarely do these muscles function again exactly as they did before you give birth without a some (sometimes a great deal of) effort on your part. And I am personally a perfect example of this. Let’s just say that even now, 6 months postpartum, things are still not at all what they once were in terms of my pelvic floor. I guess this is what happens when a baby is crowning for an HOUR and those poor muscles (the bulbocavernosous in particular, I think) get incredibly, incredibly stretched out. And yay, I didn’t tear, but man oh man–I sort of think I would have happily tore instead if it meant my muscles were just a bit stronger and less stretched out now. I don’t really want to get into graphic details, but let’s just say that I still have a lot of work to do to avoid having both a cystocele and a rectocele for the rest of my life!
While researching this on the internet, I’ve stumbled upon some fascinating information which flies in the face of conventional wisdom. Conventional wisdom suggests that kegel exercises are the answer to this sort of pelvic floor weakening problem, and in fact they’re what I have been doing primarily, and have been teaching my patients how to do for years now. Kegels, kegels, kegels! However, after reading this amazing post over on MamaSweat where Kara Thom of MamaSweat interviews Katy Bowman of Aligned and Well, I am beginning to change my mind. Katy is a biomechanical scientist who has done a lot of research into the mechanics of the pelvic floor, and in her radical departure from conventional wisdom, she suggests that squats are the answer rather than kegels. Naturally, rocking the boat like this has brought with it a bit of a back lash, including this hilarious video aimed at Katy from the “Kegel Queen” (an RN who also believes highly in the merits of kegels); even a year after the initial interview, the debate is still alive and well.
So in addition to kegels, I’ve decided to add some squats to the mix, and I’m even squatting and peeing in the shower each morning (apologize for the potential TMI right there, loyal readers!). There are also some pretty cool exercise systems out there which can be purchased, as well as physical therapists who specialize in nothing but the pelvic floor, so I’ll keep all of you posted on pelvic progress 6 months from now. But I’m also a firm believer in sexercises, too!