Many women with urinary incontinence benefit from a multitude of treatment options. From medication and bladder diaries to pelvic floor therapy, there’s no shortage of ideas for what can help women feel more in control of their symptoms. Of course, not every solution works for every woman or every manifestation of UI, which means everyone has her own journey. My UI case is a bit more extreme than others’, as I have a combination of two types of UI, brought on by a variety of conditions, including interstitial cystitis (IC). At a recent doctor’s appointment, I failed the voiding tests and my bladder diary showed that I was indeed the mess I thought I was, often urinating upwards of 18 times a day. (For reference, that’s about three times the amount folks with healthy bladders go.) My doctor and I talked about a few UI management options. I had heard good things about certain medications, but my body has a hard time even with Benadryl or any Advil stronger than 300 mg. TENS therapy doesn’t sound like any fun, and since I can’t even trust myself with an electric toothbrush, anything involving putting electronic devices under my skin isn’t really something I’m ready to explore. We both agreed that (another) surgery would be my last resort. And so we decided that pelvic floor therapy would be my best option.
However, I wasn’t sure what I had just agreed to. My doctor didn’t really know what my specific PT sessions would involve, as every course of pelvic floor therapy treatment is different, depending on the patient’s needs. Pelvic floor physical therapy involves multiple techniques that strengthen and stretch the pelvic floor muscles to relieve symptoms of a variety of diagnoses, including UI, IC, and chronic pelvic pain. For UI, specifically, it helps strengthen the weakened muscles that support the bladder, reducing incidents of stress and urge incontinence, which are the two forms of UI I have. It also helps train the motor memory of the muscles to reduce feelings of urgency. My doctor explained that the techniques include muscle strength tests (internal and external), deep breathing, yoga stretches, and biofeedback. Not knowing how else I could strengthen my pelvic floor outside of Kegels (which I dislike—who actually enjoys them?!), I trusted my doctor’s recommendation and referral for the woman who would hopefully cure all of my woes.
Walking into the office for my first appointment felt like I was going on a vagina audition. I had ridiculous thoughts like, “What if she doesn’t like my vagina? Did I wash up down there enough?” as if I were prepping for a date I knew would lead to third base and maybe even round home. My imagination also went a little bit wild: In my head bounced images of Ben Wa balls and Yoni Eggs, my knowledge of which I attribute to Freeform’s The Bold Type. Against my own usual instincts, I hadn’t Googled the techniques. I figured I would find out when I found out, come what may.
With my heart pounding in my chest and my eyes blurry with all the markings of an imminent panic attack, I entered her exam room. What had I gotten myself into?
Fortunately, she started by telling me. The therapist first asked me questions, showed me diagrams, and gave me explanations for why I felt the way I did. Telling me about herself as she went along, she explained all of her procedures. She was gentle, patient, and thorough. I learned more from her in 30 minutes about my pain and why I have it, my urges to go, and what my body is really doing down there than I had learned in the more than three years since this started. I was immediately at ease and thought, “This won’t be so bad! She gets me!” Finally, I felt understood, and that squashed my anxiety—until she put a sheet on the exam table, gave me a paper sheet to cover with, and said, “Undress from the waist down.”
I made myself as comfortable as one can be while watching a stranger lube up a gloved finger and reach under a sheet. Using her fingers, she showed me where each of my internal “trigger points” are. Trigger points are small balls of tightened fibers inside muscles that are themselves painful but also tend to refer pain to other places. For example, pressing on a certain spot on the shoulder muscles can send pain down an arm or into a wrist. The pelvic floor (especially the vagina) is made of tons of these fibers, and due to various traumas in my life, mine was packed with trigger points. I’m pretty sure I saw my therapist’s eyes light up like she had found buried treasure in there.
The large number of trigger points in my pelvic floor relates directly to my pain levels and my UI. My pelvic floor is “guarded” because everything inside of me is so tightly wound and balled up, and I am in a lot of pain most days. As a result, I have urges to go even if I don’t need to. Or in other cases, I won’t notice I have to go until it is almost too late and my muscles to try to constrict to control my bladder even more. This tightness can cause me to leak or expel a “spray” when I do get to the bathroom. In fact, having to hold my urine for any length of time likely also contributes to the creation of more trigger points. So in many ways, this is an endless cycle, and thus the need for therapy to help alleviate what it can.
Granted, having the therapist point out and work on eliminating some of my trigger points was painful. But with each press of her fingers, I could feel little knots dissolving inside of me. They felt strange, sending little bursts of warmth through me and sometimes referring pain to one of my legs, my back, or my abdomen. It was the weirdest sensation, but as each trigger point melted away, I felt a slight release in tension. The therapist said that meant they were going away. Naturally, with each one that disappeared, she warned that another could form in another spot, so it will take multiple appointments to get rid of all of them. The sessions can be very painful; I walk out of the doctor’s office a little slower but also feeling a little looser inside. She says that means it’s working.
In the month since I have started therapy, I’ve kept a bladder diary that shows improvement in my voiding skills (something I never thought I would type), and I am not leaking as much. I’m really glad my original imaginings weren’t my reality—right now, Ben Wa balls and Yoni Eggs aren’t on my must-have list. Rather, I am doing stretches at home to help soften and strengthen my pelvic floor. Speaking of which, I no longer feel tight all the time down there, and I have started to resent Kegels less, since I understand the reason they hurt so much is because my vagina is just ready to fight anything that disturbs its state of calm.
I left my first session empowered and educated on the inner workings of my pelvic floor, and now I even have a little hope that I won’t always feel like this. My pelvic floor therapist says once my muscles are stronger and everything down there doesn’t hurt as much, I may even be able to send my UI and IC into remission. If all of this can eventually lead to some reprieve, no matter how short, I am more than excited to see what’s next.