Pelvic Floor Physiotherapy: You May Be In Shape. But Is Your Vagina?

Overall, I felt really strong and in shape but was my vagina strong and in shape!? I had no idea. But I wanted to find out!


When I think back to the day I gave birth to our son, Milo, I am amazed at what my body did. Like, actually think about what it means to give birth to a baby. It blows my mind. And yet, despite the gruelling physical demands of giving birth, the vast majority of women do nothing to prepare for this trauma. Do I blame the women? No. Do I blame medicine? A little bit. Do I blame the fact that our culture thinks it is taboo or unbecoming to talk about vaginas and the perineum? Yep. Fortunately for me, when I was pregnant, my friend (a chiropractor) hosted a talk about prenatal care and the pelvic floor with her colleague, who is a pelvic floor physiotherapist. I was fascinated. I couldn’t believe that this was a thing. How had I never heard of it before? I may have heard the term “pelvic floor physio”, but I didn’t know what it entailed. After listening to what a pelvic floor physiotherapist did, I couldn’t wait to make an appointment. I practiced hot yoga for a year or so before I got pregnant and I continued with regular yoga throughout my pregnancy. Overall, I felt really strong and in shape but was my vagina strong and in shape!? I had no idea. But I wanted to find out! Considering the baby was going to be exiting through my vagina, I thought perhaps I should check out that whole situation. Was there anything I could be doing to better prepare for giving birth? I was afraid of tearing while giving birth and I was afraid of postpartum complications like incontinence and prolapse, which are two common issues post-vaginal birth. So, I was totally willing to do anything beneficial for my lady bits. 

I’ve never really been shy or anxious about vaginal exams. However, I have always had female physicians do them. Except for that one time I had really bad lower abdomen pains in high school and when I went to the emergency department, a young male doctor did an internal exam to ensure I didn’t have any cysts on my ovaries. FML! Anyways, at the initial pelvic floor physio appointment, I gave a ton of information about my history and any current issues, prior to the assessment. I didn’t have any concerns, I just wanted to know how strong (or weak) I was down there. I also wanted to know if I was doing Kegels properly (very important) because my plan was to start doing them regularly to prep for pushing out a human. I kid you not, after the assessment she told me my pelvic floor muscles were almost Olympic strength. On a scale of 0-5, they were a 4. I was so freakin’ pumped. I couldn’t wait to go home and tell my husband (who is a urologist I might add). My vagina was Hercules in my mind. While I was pregnant, I did my Kegels (whenever I remembered to do them) and I mostly practiced releasing the Kegel, which is also important. My muscles were strong but being able to contract and release properly is also key!

My pelvic floor physiotherapist taught me about perineal massage and showed me how to do it. It made SO MUCH SENSE to me and I was shocked that I had never heard of it before. Like hello! A human is coming out of your vagina soon… maybe you should help it out a bit and prep the area!? If you’re interested in learning about perineal massage, there are lots of informative sites that describe it and explain how to properly do it. You’re basically stretching your vagina. People don’t even embark on a simple 30-minute workout without doing some kind of body prep (warm-up, stretching, etc.). Think of all the prep and training that people do before running a marathon. Well, labour and childbirth is a marathon. A kind of marathon where once you cross the finish line a human bursts out of your vagina. Imagine! So, we should be preparing the body as best we can. 

One day I hope that pelvic floor physiotherapy is just a regular part of standard health care for pregnant and postpartum women. Ideally, it would be a standard physical exam for ALL women. Kind of like the Pap test. With regard to childbirth though, the research has consistently shown that pelvic floor muscle training results in a significant reduction in the duration of the second stage of labour and reduces the incidence of urinary incontinence. Perineal massage during pregnancy can increase the likelihood of having an intact perineum following childbirth and is related to lower grade perineal tears and less perineal pain postpartum. For me, my pelvic floor muscles were strong AF before giving birth to my son. And I am so happy they were. I had minimal tearing and no vaginal or pelvic floor issues (so far). BUT, I am still working on strengthening my pelvic floor because a few weeks ago I had to pee SO BAD but I was holding it while tidying up around the house (I’ve been doing this since I was a kid… when I’m busy, I can’t be bothered to go pee). Well, I sneezed and pee came out. I couldn’t believe it. So, clearly I have some work to do to bring my Hercules vagina back to life. 

You may have heard about incontinence and prolapse. But, what exactly are they? 

Incontinence is defined as a lack of control over urination. There are multiple types of incontinence but, two of the most common that affect postpartum women are:

Stress incontinence: Leaking while coughing, laughing, sneezing, etc. Caused by weak pelvic floor muscles and can result from trauma during childbirth. 

Urgency incontinence: Strong sensation of having to go pee and leaking before you can get to the toilet. Can be related to numerous factors including overactive bladder or voiding dysfunction which can be secondary to hypertonic pelvic floor muscles (tight muscles). 

Sounds fun, eh? (I’m Canadian). You are probably most familiar with stress incontinence. It’s very common to hear about a woman leaking urine when they cough or sneeze (like I did). You see commercials for big absorbent pads or adults diapers for women. It’s talked about in our society as if it’s normal and should be almost expected after giving birth. Kind of like “well, I had a baby so I’m leaking… end of story.” Does the thought of sneezing, laughing, or jumping give you anxiety because you know you’re going to pee yourself? Do you wear panty liners every day? A misconception about incontinence is that your pelvic floor muscles MUST be weak. This is not always the case. You can have hypertonic (tight or stiff) pelvic floor muscles too. Isn’t that wild!! So, you can’t just assume your muscles down there are weak and think that the answer to all your problems is to strengthen them. You could be too tight down there and have to work on releasing the tension. This is why getting a pelvic floor assessment (by a trained pelvic floor physiotherapist, obviously) is so important. You need to know what your issue is. You could also have scar tissue built up from tearing during childbirth. You could be tight on one side and not the other, etc. 

Prolapse is defined as a slipping downward of organs in the body.

Doesn’t that sound horrendous!? Prolapse means that one of the pelvic organs (uterus, bowel, bladder, and/or rectum) are bulging into or falling out of the vagina. Symptoms can include a sensation of a bulge or something coming down or out of the vagina, pain during sex, pain or difficulty using tampons, and difficulty urinating or passing stool. Depending on the severity of prolapse, significant pelvic surgery may be needed for treatment. Prolapse is not directly a result of childbirth, however, childbirth can cause a weakening of the pelvic floor muscles which can then lead to prolapse. Having strong pelvic floor muscles prior to giving birth can help prevent damage during childbirth and muscle weakening in the postpartum period. If this last paragraph about organs dropping doesn’t make you want to book a pelvic floor physiotherapy appointment, then I don’t know what will. 

What if you were in labour but ultimately your baby was born via c-section?

Many people assume that incontinence and prolapse are unique to women who have had a vaginal delivery. HOWEVER, the pressure put on the pelvic floor during a prolonged labour that ultimately resulted in a c-section can lead to the same postpartum issues.

Incontinence and prolapse are COMMON in women but don’t be fooled into thinking they are NORMAL.

Incontinence and prolapse are COMMON in women but don’t be fooled into thinking they are NORMAL. They are also not issues that you have to just accept and live with. Too many women live with these issues and have the attitude of “well, I’ve had children, so…. that’s the end of that.” NO! Stop it! There needs to be more conversation about vaginal health. Sex should not be painful for women. If it is, you should consider going to see your family physician and/or a pelvic floor physio. Why do I see commercials about Viagra for men who have a hard time getting an erection and ZERO commercials about anything to do with vaginal health (with regard to sex… not yeast infections *eye roll*). 

Yes, I get it. It’s an internal vaginal exam. It’s a little awkward. You literally lay there while the physiotherapist is up your va-jay-jay asking you to perform Kegels, examining all your muscles and chit chatting about the weather. But, think about how much you are going to benefit from understanding what is going on down there and learning how to properly fix anything that may be causing discomfort. Also, they do this all day. They do not care about vaginas. They see them ALL DAY.

It’s just a vagina. But, it’s your vagina. So, take care of it!

XOXO Renee Reina

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Pelvic Floor Physiotherapy: You May Be In Shape. But Is Your Vagina?