Do You Pee in Your Pants? Let’s Talk.

First off, one of my goals in writing this blog is to annihilate the 3 nasties. Shame. Stigma. Silence. Got it? Ok… Let’s move on.

I am 100% positive that a lot of grown women pee in their pants (especially after childbirth). I know this because I have talked to many of them (my sample size is around 50). Also, my older sister, Dr. Nazema Siddiqui (aka “Naz”), a urogynecologist, specializes in pelvic floor disorders and incontinence and she has a lot of patients.

So today, I want to discuss how you can stop peeing in your pants through pelvic floor physical therapy. I’m not claiming that it will allow you to lift a 10 pound weight with your vagina like this woman, but it can help with incontinence (and pain).

So, What Is Pelvic Floor Physical Therapy?

In laywomen’s terms, it’s internal physical therapy that helps with pain during sex (it should not be painful), incontinence, bowel dysfunctions. Women have been increasingly discussing postpartum pelvic floor PT, but it is still pretty uncommon in the US, unlike in Europe.

3 Main Reasons You Didn’t Know About This

1. We are not educated about this, en masse, in the US. I admit that I would not have known about this type of PT it if was not for Naz who specializes in pelvic floor disorders and incontinence.
2. It is prohibitively expensive. In the US, It is *hard* (but not impossible) to find access to providers who accept health insurance.
3. Most OB/GYNs say women are healed 6 weeks after giving birth, but internally they are not and (most) OB/GYNs don’t refer patients to pelvic floor PT. Why? Because OB/GYNs are not trained to understand this type of dysfunction! Urogynecologists on the other hand routinely refer their patients to pelvic floor PT (they are OB/GYN sub-specialists who focus on pelvic floor disorders). My understanding though, is if you make it to a urogyn, you have a really bad case of whatever is going on down there. Since most of us don’t need that specialized care, we just sit in limbo, peeing in our pants and/or engaging in painful sex thinking that is normal (Read: It’s not).

Finding a Pelvic Floor Physical Therapist

I’m pretty astute at navigating bureaucratic systems and it still took hours and dozens upon dozens of phone calls to find a PT who both specializes in pelvic floor PT and accepts health insurance . . . in NYC! I can’t imagine how difficult this would be if I lived in a rural town.

I finally found Duffy & Bracken Physical Therapy (this is not sponsored). They are located in Downtown Manhattan and accept most health insurance plans (I had a $20 co-pay). I have now had pelvic floor PT conducted by Ann Duffy (coccyx injury) and Bhavti Soni (bowel dysfunction during pregnancy and pain with sex and incontinence during the postpartum period). I used to think PT was BS, but pelvic floor PT has honestly changed my life.

I Have So Much To Talk About

But today, I’m only going to focus on incontinence.

Here are 6 Things That I Learned at Duffy & Bracken

1. Your pelvic floor is like a sling or a hammock and many of us have been doing kegels wrong. There is a front, middle and back kegel, who knew? Once you learn the correct way, it’s easier to hold in your pee.
2. It’s 100% normal to pee in your pants and leak after giving birth even if you had a c-section. You just need the proper care to heal. Beware of coughing.
3. There are many exercises that help to strengthen your pelvic floor and exercises that can make your condition worse (i.e. sit-ups). It is important to know the difference if you want to heal.
4. If you have key-in-lock syndrome (you get a sudden urge to pee out of nowhere the minute you enter your home), this type of PT can help you. I was really bad after giving birth, but I am so happy to say I have been accident free now for months!
5. There are vaginal video games that strengthen your pelvic floor strength. You get a personal sensor at PT that you insert into your vagina and it’s hooked up to a machine. Sometimes the graphic is a flower opening and closing (according to Naz). My graphic was like an Atari game. You squeeze your pelvic floor, hold it and the graph pings when you hit 20. IT IS SO HARD AND SO MUCH FUN.
6. You can bring relaxation music. Ok, this is more of a tip, but it’s important. I was SO NERVOUS about pelvic floor physical therapy at first. I was told to bring in anything to relax and a Spotify spa playlist and headphones did the trick.

I will leave you with a useful gem – “Imagine putting a diamond into your vagina and squeezing it up out of your head”. This is a pelvic floor visualization that Ife Obi, the owner of The Fit In Bed-Stuy tells us during class. If you need help with incontinence, visualize that (and tighten) over and over again, until you find yourself a pelvic floor physical therapist, of course.