This Mother’s Day is an important milestone for me as a mom. My oldest daughter, Midori, will graduate from college two days before Mother’s Day.
My oldest daughter is the reason I became interested in pelvic floor physical therapy. One of the most common questions I get from my physical therapy (PT) friends and patients is, “How in the world did you ever get interested in pelvic floor physical therapy?”
If someone told me when I was in PT school that pelvic floor PT would be my specialty, I probably would have laughed out loud and questioned that person’s sanity.
Here is my story.
An Unexpected Arrival
Midori was an unplanned pregnancy. We had recently moved to Colorado after living in Japan for three years. I just got a job in Denver as an outpatient sports medicine PT. It was a little stressful: new job, new country, new home—but it was also exciting.
Luckily, my pregnancy was awesome. I loved the feeling; I never had any morning sickness or pain. It was a blessing to feel so good!
My husband and I decided not to find out the gender of our baby. Everyone predicted a boy and made comments like, “You’re carrying a boy because you are carrying this baby so low!”
Carrying so low may have had a consequence (along with some genetic factors) because towards the end of my second trimester, I felt a ‘bump’ in my perineum. We didn’t own a computer at the time, so I checked the Merck’s manual I still had from PT school on medical diagnoses and it listed possibilities such as a tumor—or a prolapse.
My next appointment with my OB/Gyn was not helpful. My doctor held my hand and assured me I had a “normal vagina.” I was lying down for the assessment.
I then did more research on my own.
During the following doctor visit, I requested that my doctor evaluate me while I was standing. By then, I knew it was not a tumor (thank goodness) but a cystocele or a bladder prolapse. My doctor was surprised and identified it as a cystocele, recommending a pessary if the cystocele was bothersome to me.
What Is a Pelvic Organ Prolapse?
A prolapse is the abnormal descent of a pelvic organ which results in a bulging in the vaginal area.
There are five common types of prolapse into the vagina:
- Cystocele: the bladder descends into the vagina
- Urethrocele: the urethra descends into the vagina
- Rectocele: the rectum descends into the vagina
- Enterocele: the small intestines descend into the vagina
- Uterine prolapse: the uterus descends into the vagina
What is a pessary?
A pessary is a removable device that is inserted in the vagina to support the prolapsed organs. It is also used to treat stress urinary incontinence, a retroverted uterus, cystocele and rectocele.
Fortunately, my prolapse was asymptomatic. But I did become one of the 1 in 10,000 who develop a prolapse during pregnancy and not after delivery. 1
Despite that, pregnancy continued to be amazing for me. Labor was a powerful and beautiful experience: no drugs and only five hours of labor!
However, I did get an episiotomy. (A reminder, this all happened before I knew anything about pelvic floor and women’s health physical therapy.)
It was one of the best days of my life; we had a beautiful healthy daughter. We named her Midori after my mom.
But, my prolapse was no longer asymptomatic, postpartum I experienced symptoms of perineal pressure and stress urinary incontinence.
At my six-week postpartum follow-up appointment, I brought up my prolapse symptoms. My doctor patted me on the shoulder and said, “Just do your Kegels, dear.”
Sitting there alone, after she left the room I remember thinking there had to be more than just doing my Kegels.
From that moment, my continuing education and self-study has focused on pelvic health and women’s health physical therapy.
How to Treat Pelvic Organ Prolapse
And indeed, thankfully there is more to it than “just doing your Kegels.” Treating pelvic organ prolapse includes:
- The coordinated orchestration of all the core muscles, the diaphragm, transverse abdominis, multifidus (lower back) and pelvic floor—they all work together.
- Proper posture: Thoracic kyphosis and decreased curvature of the lumbar spine is a risk factor for prolapse.
- Constipation management: Avoiding constipation is very important with any pelvic floor dysfunction, and especially with prolapse.
- Proper bracing when lifting, coughing and sneezing to protect the pelvic floor and pelvic organs.
A New Purpose
My passion in physical therapy really did turn to pelvic health. Initially, my patient population consisted of postpartum moms and menopausal women with incontinence and prolapse. The focus on the pelvic floor has evolved, and now I see patients with complex pelvic pain in both males and females, as well as children with pelvic floor dysfunction.
This Mother’s Day, I think of my daughter as she graduates from the University of Colorado. I couldn’t be more proud of this brilliant and beautiful young lady.
She is the reason for my prolapse, the reason for my purpose and passion in the field of physical therapy.
1Law H, Fiadjoe P. Urogynaecological problems in pregnancy. Journal Of Obstetrics & Gynaecology. February 2012;32(2):109-112.