How I'm finally training my pelvic floor post-baby — and the weird events that got me here

Last fall, I ran my third half marathon — my first since giving birth over two years ago. Everything was running smoothly (haha!), until I got to the 16-kilometre mark. I had the intense urge to pee, but, being slightly competitive, I decided I wasn't going to stop for a bathroom break. Within minutes I felt a slight release, even though I thought I was holding it. For the last five kilometres of the race, I would intermittently pee a little bit more.

This was something that I had never done before, and I was certainly not prepared for it. Sure, I'd peed a little when laughing or sneezing (who hasn't?), but this was different. It felt like I was holding it, and suddenly everything would give, like I had no control.

After having my daughter, I hadn't thought much about my urination schedule and how often I was going — I work from home and can go whenever I want. But after my race experience in October, I realized that something wasn't right. I was, in fact, peeing more frequently (once an hour at times), and I had experienced some "emergency" feelings that prompted racing to the bathroom.

Getting to the bottom of it

I recounted my concerns to a friend of mine who, after a stressful birth due to a tight pelvic floor, started looking into pelvic floor health. She recommended that I reach out to a pelvic floor physiotherapist for a proper assessment. At around the same time, a new pelvic floor fitness app launched in Canada and landed on my desk. (I'm a freelance writer and I write about various products.) Called the Elvie, the makers dubbed their product the "Fitbit for your lady bits." The Elvie device connects to an app on your phone and then creates five-minute exercise routines that have you squeezing the device internally to reach certain goals. So, all signs were pointing to me taking my pelvic floor health a little more seriously — I am almost 40 years old, after all, and someone who doesn't want this to worsen as I get older.

What I didn't know before my appointments with Anna Glistvain at Synergy Sports Medicine & Rehabilitation in Toronto, was that pelvic floor muscles help control our bladder. "What a lot of people don't realize is that the pelvic floor actually contracts the external sphincter of the bladder," says Glistvain. "Anytime you cough or sneeze, that external pressure presses down onto the bladder, so if the pelvic floor is weak, it just lets go. There's no support for the bladder to lift up and to keep it closed."

And the pelvic floor does more than just help control the bladder: it helps stabilize and control the pelvis, it supports our organs and even plays a role in our sex life.  

On my first visit, Glistvain did internal and external exams and noticed that my bladder had been potentially squished on the right side while I was pregnant (the right side was where my daughter liked to hang out most towards the end of my pregnancy!). She believed this was one of the major causes of my incontinence because this meant my bladder wasn't able to fill up properly. She also noted that my pubovaginalis muscle, part of the pubococcygeus muscle in the pelvic floor that controls the flow of urine, was a bit weak.

Those first few weeks post-baby are quite intense, as any new mom will tell you, so things like pelvic floor health often aren't top of mind after giving birth, and certainly need more attention. Glistvain recommends that pregnant women come in for an assessment at 30 weeks and postpartum women after six or eight weeks. "A lot of women have incontinence prolapse or possibly dyspareunia [painful sexual intercourse], and they think they just have to live with it. The reality is they don't, and a lot of these things can be treated."

I would like to see Canada adopt postpartum care similar to that from across the pond. In France, for example, any woman who has had a baby is prescribed 10 free pelvic floor therapy sessions. Here at home, my insurance covers physiotherapy in general, with pelvic floor therapy being included within that. But our plan is capped; my husband's employer's insurance plan maxes out at $500 a year, which would only cover about four sessions. I'll likely not be able to go beyond these four, even though Glistvain recommends up to 10 visits.

What's a woman to do?

Glistvain believes, depending on severity, that most issues can be sorted out after six to eight sessions — even if you wait over two years like I did (but getting in sooner is obviously better!). These sessions can even help you avoid surgery later in life. "It's never too late because it's just a muscle," notes Glistvain, who has successfully treated clients of all ages, including people in their 50s, 60s and older who have fixed pelvic floor issues through exercise. "That's what most people don't realize. It's just like the quad or the hamstring or the bicep. A muscle can be weak, a muscle can be tight. If it's weak, we just need to strengthen it, and it goes back to its normal functional level. It may take a little bit longer, but we can definitely heal it."

She also notes that women who deliver vaginally may have different issues than women who have Caesarean sections — but that both require a double-check. "Whether they've had a vaginal delivery or a C-section, both can actually cause complications," she says. "I see a lot of women after C-sections that either have discomfort or numbness in the abdominal area. They can [also] get hip pain and back pain, because they lack good core strength, because with a C-section you're cutting through a lot of the muscles."

After my first session, I was sent home with a diagram of the pelvic floor muscles, as well as a list of 10 exercises to do twice per day. I did incorporate the Elvie device into my schedule (Glistvain says some women are actually prescribed these types of devices over in Europe), which recommended three workouts per week. I found it really helpful to be more aware of the muscles that I should be working, and not just focusing on doing traditional Kegel-type squeezes, when doing these exercises.

Glistvain strongly suggests an assessment before using a device like this is also extremely important. "If a person that has a tight pelvic floor, the Elvie device can potentially make it worse [if] it's already really tight," notes Glistvain, "versus a person that has a weak pelvic floor."

At my second appointment, there was a noticeable improvement in my pelvic muscle strength, and my bladder appeared to be coming back into proper shape. The Elvie app also says I have been improving with each workout. I, too, have noticed that I don't have to pee as frequently, and the urge to go to the washroom is not as strong. I am certainly motivated to do the exercises more frequently, given my slight improvement already. My goal is to break two hours at my next half marathon this coming October. Oh, and to not pee my running tights.