Unfortunately, this next blog is the part where I'm brutally honest about peeing in my pants. As if telling you about my pain with sex in the last blog weren’t enough I'm opening up here in ultimate vulnerability because this part of the story is honestly much harder for me to write. It's required a lot deeper work.
Despite being a pelvic floor PT and talking about this stuff ALL DAY, I still hold a lot of shame, embarrassment, and self-judgement about my own history of urinary issues. I've learned that we all have our own pace for healing and my decision to share this story with you is an important step in regaining my confidence and power around this part of my health. I can't express how much gratitude I've had for my experiences, because they've shaped who I am as a person, a clinician, a partner, and have helped me to become clear on how and why I want to help people with pelvic floor dysfunction.
All right...here goes: I was a couple of years into my PT career and I decided it was time to dive into pelvic floor course work so that I could start to specialize. The Level 1 course consisted of general anatomy and physiology of the pelvic floor, bowel, and bladder; visual identification; tactile identification and treatment techniques; an introduction into common pelvic floor pathologies; and a focus on management of incontinence. I left the training feeling confident that I was meant to be doing this work and ready to see my first patient.
My world started to revolve around talking to patients (and my friends and family) about their pelvic floors, their urinary habits, and how well they were pooping. I didn't make these connections at the time, but this also happened to be taking place during a period in my life in which I was pretty unhappy in my job location, dealing with relationship and family stress, and generally feeling anxious for much of my day. In an effort to maximize sleep and save time in the mornings I started to pee in the shower. HUGE MISTAKE! A big part of urge incontinence has to do with the signals our bladder, pelvic floor muscles, and brains feed to each other. By initiating peeing in the shower I was teaching my brain to associate running water with urination. I had noticed a little urinary urge around water for a few months, but then one day I was standing in my bedroom just thinking about taking a shower. As I started to undress, my bladder went rogue and decided it didn't care if we were in the shower, on the toilet, or in my bedroom. I stood there in shock, literally peeing all over my legs and the bedroom floor. I knew all about kegels and strategies to stop leaking, and yet my pelvic floor wasn't listening to me when I was screaming "STOP!" I yelled to my boyfriend, who was in the other room, that I couldn't stop peeing. We both started laughing, because really what else can you do in such complex moment? I was embarrassed, scared, ashamed, and in disbelief at what had just happened. My body and brain were playing tricks on each other and, despite my full intellectual knowledge of why and how, the wiring was crossed.
This nightmare scenario ended up repeating itself two more times before I really got freaked out—which didn't help the situation at all, by the way. I went back to see Judy for some more PT. We discovered that my pelvic floor was hypertonic (a very common cause of urinary dysfunction) and that my urethral sphincter was a little tight on one side, which may have been contributing to loss of control. After a few manual sessions I thought I was in the clear, but in the back of my mind I knew there had to be a root cause for this hypertonicity, tension, and signal crossing. Still, I went on with my life assuming that my urinary issues had been short-lived.
Cut to about a year later when I started my work at The Pelvic Health and Rehabilitation Center, a clinic that treats patients with pelvic floor dysfunction exclusively. To say that I was excited for this job would have been an understatement. This was just the opportunity I'd been looking for to dive into my pelvic floor passion and I would get to train with some of the world's best physical therapists. I guess my body, in its infinite wisdom, wanted to get in on the opportunity, too. I noticed within the first work week that my urinary urgency symptoms were returning with cues like water, pulling in the driveway, putting the key in the door, and finishing up with a client at work. I couldn't help but to notice the irony that while I was helping people all day long with urinary urgency and frequency issues, I was stealing desperate glances at the clock, wondering when I’d next be able to pee.
Despite loving my job, it was intense and new and came with a gnarly commute. Luckily, I had the best pelvic floor PTs at my disposal and as I got used to the job, received manual treatment, and managed my long-standing constipation, my symptoms died down.
After about six months I relocated from the San Francisco to the Los Angeles location and noticed a return in symptoms. Here I was again in a new environment, with new patients, a heavy case-load, and a really intense patient population (whom I love). With this stress, my urge incontinence came back with a vengeance. I started having to pee on the hour every hour. I started leaking small amounts throughout the day and the key-in-the-door incontinence caused me to run my washing machine way more than I should have been during this drought.
My boss and I established a treatment plan and bladder retraining strategy, but I was still having occasional leakage and severe frequency. I was so frustrated! I loved my job and was really good at helping people eliminate their pelvic floor issues. Why the hell couldn't I figure out my own?!? It was at this point that I realized I might need to start practicing what I was preaching a bit more.
I’d had a steady yoga practice for 7 years at this point and through this practice I’d been able to see the benefits of yoga on multiple levels in my own body and life. In addition to manual therapy I emphasize a yogic approach to managing pelvic floor dysfunction with my patients. This includes physical poses, breathing techniques, meditation, and a consideration of the emotional and energetic systems that affect our health. I decided I needed to start tuning into my own body, my psychological and emotional states, my hormones, nutrition, and my external stressors more closely. I've always been someone who thought I knew my body really well; however as I started to pay more attention it became pretty obvious that stress, at this point, was the biggest trigger for my symptoms, and that my body was unhappy in many ways—my bladder had just been the first thing to spring a leak (pun intended) to get my attention.
In November 2015 I decided that I had reached a point where I needed some really focused time to dedicate to self-care. So I did the best and hardest thing I could do: I left my job and the security of the officially sanctioned professional path. Why? Because my healing and my calling had to take priority.
It's been a gradual process, but I've sifted through and applied mindfulness to my stress at work, my emotions, down-regulating my nervous system, eating cleanly, my relationships, balancing my hormones, exercising, managing constipation, clearing energetic blocks, and generally listening to what my body has been telling me. I've gone to therapy and yoga retreats, journaled and visioned, gone deep into my yoga practice, and I finally feel better now that I'm walking a path that feels right in my body! I know that my pelvic floor issues are multi-faceted and multi-factorial, as many of my patients' are, but I also know that only by listening to my gut and my intuition have I been able to address the root cause of my problems.
I can (and will, in upcoming blogs) tell you dozens of stories about patients I've helped using an integrative and holistic approach. However, my passion, my business, and my offerings to my readers and clients are all the culmination of my own experience. They are the product and synthesis of all the self-work I've undertaken along the path to personal and professional development, discovery, and striving toward optimal health in its many forms. I invite you to keep reading my blogs and engaging with my online content to learn more about conscious care for pelvic health.