I have a prolapsed uterus, something I wrote about a few months ago. My OBGYN suggested Kegels to start. She mentioned physical therapy but said if I didn’t get better, I might need a pessary, a device inserted into my vagina to hold up my uterus.
Needless to say, I started doing Kegels every day. It took a few weeks before I could do them without any pain. Then, as anyone who has done any form of exercise knows, I plateaued. I reached a point where I could do Kegels, but I didn’t seem to be getting any better. Also, the only thing Kegels improved was my ability to do Kegels. My cervix was still peeking out saying hi every time I looked.
So I decided to go to physical therapy. My first appointment was as awkward as possible, which I dealt with by being as funny as possible. Michelle, my physical therapist, started by asking me roughly 10,000 questions. Michelle now knows more about me than any other person on the planet. She knows how often I go to the bathroom, if I leak urine, what sexual positions are painful, the frequency of my bowel movements, my menstrual history, if I wet the bed as a child. I know Michelle’s first name.
The next part of the exam was what you would expect: a physical. I wore a skirt for that reason, so I felt much less exposed than I would if I had been wearing their thin, white cotton sheet. So I took my undies off, hopped up on the table, and spread my legs. She started with a visual exam and then lightly pressed on my stomach, thighs, and crotch to see if I had any tender tissue. Apparently, tissue is not supposed to be tender. This is news to me because the area around my uterus has always been tender. I thought that was normal.
The next part sucked. She stared at my vagina while I did a Kegel, coughed, and then bore down. I definitely didn’t cough normally and it was actually hard to bear down. It’s like trying to pee when someone is rushing you. But sure enough, my cervix eventually popped out. Michelle seemed almost excited because now she knew what she was dealing with.
Then Michelle stuck her finger in my vagina. It wasn’t as unpleasant as gyno exams because she was doing everything by feel so she wasn’t looking at me; she was very politely staring at the ceiling. It seemed less personal and I was less self-conscious.
She had me do a Kegel with her finger at one inch, two inches, and three inches inside me. She had me hold a Kegel for one second, two, three, and then four seconds. She stopped me after four seconds because that’s when my legs started shaking a little. As in, I can only hold a Kegel for four seconds. And I thought I had been doing so well.
After literally getting a feel for what I could do, she started teaching me how to do the physical therapy exercises I would be doing. Apparently Kegels have two parts: there is the squeeze in, and then the pull-up. I didn’t have the pull-up part yet, which is why me doing Kegels didn’t move my cervix. So there I was, lying on a table with my butt on a pillow to take advantage of gravity, with Michelle’s finger inside me, and me concentrating so hard my eyes screwed up, and... nothing.
It’s not that it was hard; I literally couldn’t do it. She told me to do a Kegel and then tighten my rectal muscles like I was holding in a fart. After a full 30 seconds of me laughing, I tried it. Half the time she said she felt the pull, the other half she didn’t feel anything. I have no idea what I was doing correctly because it didn’t feel like anything to me.
Apparently, your traverse abdominal muscles run from your hips to your ribs and are supposed to activate every time you do anything. Even raising your arm, your traverse abdominals are supposed to fire. Mine do not. I don’t have access to them. Because they were weak, the stronger muscles in my legs, stomach, and even arms overcompensated, weakening my traverse abdominal muscles even further until they were useless. Thanks, body.
In order to access those weak muscles, I have to fatigue my stronger ones. This involves me lying back with my legs bent up. I put my hands on the tops of my thighs and push away, using my thigh muscles to push back on my hands. And then nothing happens. After two solid minutes of me feeling like a defective idiot, my legs and arms actually start shaking and what feels like a bunch of stretched rubber bands between my hip bones rises up from inside my body to right under my skin. My traverse abdominal muscles, waking up after a 20 year nap, coming to say hi.
It was an interesting sensation. My other muscles felt fatigued, like a deeper, sore feeling I have felt many times. My traverse abdominal muscles felt sudden and new and different, like a cut or a charley horse. Michelle told me they would feel like menstrual cramps for a few hours. And then she told me to it every single morning. I got an IUD because I didn’t want cramps anymore, and the only reason I know about my prolapse is because I saw the IUD strings, and to fix my prolapse I essentially have to give myself cramps. What the hell, universe?
Also, I have been breathing wrong for my entire life. Sit on the edge of a chair with one hand on your lower belly and one on your chest. Breathe normally. If you feel something in your lower belly and a little bit in your chest, congratulations, you breathe right. I felt nothing in my lower belly; it was all in my chest. Every time you breathe in, your pelvic floor is supposed to pull up. Mine wasn’t. So my first homework assignment was to work on breathing correctly.
My other homework is hell. I have to do 10 Kegels as quickly as I can but making sure I relax fully between each one. Then do 10 reps of those. So 100 Kegels. Then, she wants me to do what she calls "Kegels Plus," which is where I pull in my rectal muscles so I get that pull up in my pelvic floor. One hundred, as quickly as I can. I have to do those twice a day.
Then I have to hold a Kegel Plus for four seconds, relax for four seconds. I do 10 of those, five times a day. I went from doing maybe 20 Kegels – when I remembered – to doing 450 a day.
I’ll be honest: I couldn’t do it. I’d be a Kegel machine on overdrive when suddenly the gears wore out and I just couldn’t do any more. But after just a few days, it started getting easier. I also stopped doing the plain Kegels because I finally figured out the Kegel Plus! I can totally feel the pull up when I do it and my traverse abdominal muscles get involved on their own, which is nice.
The one other exercise she has me doing at home is that traverse abdominal muscle activation hold. That was the easiest one by far because I was supposed to get tired. Except after a few days, I couldn’t get tired. I couldn’t feel the traverse abdominal muscles rise up over my sore abs and legs. Which is good. They are getting stronger.
Of course, I told Michelle this and she told me there are ways to make it harder. Of course there are. First, I can pull on a band instead of just pushing on my legs. I can also raise my knees back and forth, even doing a reverse crunch if I am so inclined (I am not). I can also squeeze a ball between my knees. Every time I get good at something, she just makes it harder.
My second physical therapy appointment was not what I expected at all. I wore yoga pants under a skirt because I wasn’t sure what we were going to be doing. I kind of thought I would be doing all those Kegel holds but with a biofeedback machine up inside me to let me know if I was doing them correctly. But instead, I worked out – a lot.
Now, I am not a doctor. I don’t even play one on TV. So I can’t tell you guys what to do. But I can tell you guys what I do. So, here are the exercises I do for my prolapsed uterus:
Walk backwards. On a treadmill (or on your walk/jog) walk backwards for a few minutes. This activates and warms up your traverse abdominal muscles.
Balance. Using a foam pad, place one foot in front of the other for 2 minutes. Switch feet. I suck at this one. I am constantly almost falling over. I feel it in my traverse abdominal muscles but they aren’t strong enough to hold me steady yet. UPDATE: After a few weeks doing this, she made it harder by putting me on a wooden balance board. It is impossible.
Hip rotations. On an exercise ball. 20 clockwise, 20 counterclockwise, 20 side to side, 20 front to back. Try to keep your spine straight and just move your hips. Make it harder by holding a Kegel Plus as you rotate. I feel ridiculous when I do these because they remind me of sexy club dancing. In fact, I do these in the car while I’m rocking out to some hip tunes. Hip rotations get harder the stronger you get because you can hold your Kegel Plus higher and it kills your lower abs. I get all sweaty and start breathing hard.
Clams. Lay on your side with a band (you can buy them anywhere) tied loosely around your knees. (Make sure you don’t lean back; keep your hips completely vertical.) Lift your knee up, KEEPING YOUR FEET TOGETHER — 20 times each side.
This one is shockingly difficult. The first one was easy but I only because I did it wrong. I lifted my entire leg, including my foot, up. Once I kept my feet together it became more of a pivot motion that only involved my outer thigh and butt muscles. I can do 10, then I have to rest, then I do five, rest, then do the last five. Then I rest for awhile before I switch. These are HARD.
Froggy Kegels. I call them that because that’s what they are. Michelle calls them Stomach Kegel Holds because she’s boring. You lay with a pillow under your stomach, spread your knees out, bend them and put your feet together. Then you do 20 Kegel Plus holds.
I feel this everywhere. THIS is how people should be doing their Kegels because it activates all those muscles you’re supposed to be using and you can’t cheat.
Sit-to-stand Kegels. Sit on the edge of a chair, holding a two pound ball. Hold a Kegel Plus, stand, then lift the ball above your head, bring the ball back down, then sit. Don’t forget to breathe properly.
These are stupidly difficult. I constantly drop my Kegel when my arms go up. It’s been weeks and I still have trouble with these.
Elevator holds. Imagine your vagina is an elevator, but without the music. Do a Kegel Plus, but only go to floor one, then floor two, then floor three. Then go back down again.
This is the real test of how strong your pelvic floor is. Most people can go up floor by floor, but the real trick is to go back down. I got stuck on the third floor for a while and then it all came crashing down anyway. I worked hard on these all day and I finally got it. I actually like doing these instead of regular Kegels. They are weirdly fun and make me weirdly proud that I can do them.
I gotta tell you, I’m a little upset that there are so many exercises for your pelvic floor that are simple to do at home and yet no one knows about them. If you Google “prolapsed uterus” all you get are Kegels, Kegels, Kegels. And apparently, just squeezing in is only half a Kegel. If you Google “pelvic floor exercises,” you mostly get squats or planks or jumping around. Well, if you have a prolapsed uterus, you shouldn’t be doing squats or jumping around. And planks suck. Those exercises are for preventing prolapses, not fixing one.
I’ve only gone to physical therapy a few times, but I am feeling a difference. My cervix is no longer peeking out all the time, and I didn’t realize I was in a low constant pain around my uterus until it was gone. And did you know you’re NOT supposed to get up to go to the bathroom two to three times a night? I joke around a lot, but I’m actually angry that this isn’t more widely known. My physical therapist has most of these exercises printed up on a worksheet. Why are they such a big secret?