How pelvic floor therapy helped me find ease after cancer.

Four years ago, I went to a cancer wellness fair run by our local cancer advocacy group, Enliven. In late 2019, I was diagnosed with stage 3a endometrial cancer that was found in my uterus and ovaries. I had a bi-lateral salpingo-oophorectomy with hysterectomy. Which means they removed my ovaries, uterus, ovarian tubes, and cervix. Oh, I miss them all dearly.

At the wellness fair, a physiotherapist discussed the importance of the pelvic floor. I knew that many women who’d had my surgery experienced complications with their pelvic floor, and I had benefit coverage, so I decided to be proactive and reach out. (Complications with pelvic floor can include urinary incontinence, something that affects a quarter of women and that number skyrockets among women who have had vaginal births, but there is so much more that can go awry in the pelvic region and we don’t have to just cope with these pains and effects).

During the q&a of her presentation, I asked her if we should be doing kegels to support our pelvic floor. (Shout-out to Brittany at PhysioWorks, a god among women)

Her answer to that forever changed how I interact with my own body.

Here’s what I emailed her after the fair.

I really appreciated your answer to my question about kegels. 

You mentioned that relaxation is needed before exercising that way – do you have any handouts about that, some practises I can follow? 

I have definitely noticed that I have to consciously relax, it is not natural, and most of the time I am soooo tense in my pelvic area. It feels like I’m always bracing myself as if I’m anticipating going around sharp corners in a vehicle! Lol. Help would be so appreciated.

Her response was thorough. I’ve shared some of it here:

Like I mentioned in the talk, it is quite common to think we need to do Kegels straight away for pelvic floor issues, after cancer treatment, or after a hysterectomy. While Kegels are a great exercise and almost all of my clients get them at some point in their rehab, many women (and men) need to start to decrease the tension/holding/guarding first in their muscles. This is so common! 

It seems incredibly obvious to me that the reason kegels get recommended so much is because, as with anything to do with women’s health, it’s only considered important if it can benefit men (I mean, I learned about them from Seventeen magazine). Kegels are seen as having the effect of ‘tightening’ the vagina. And for whom is this?

Here are some things pelvic floor therapy can address that actually help women: bladder issues: incontinence, overactive bladder, frequent, painful, or incomplete urination. Bowels: incontinence, constipation, pain during bowel movements. Pelvic: pelvic floor muscle tension or spasm, vulvodynia, vaginismus, dyspareunia, nerve pain, organ prolapse, perineal tearing recovery, hysterectomy recovery, skeletal pain, and plenty more, if you can believe it.

Pelvic radiation can also cause dramatic changes to the pelvic region. I had dramatic aftermath from the surgeries including scar tissue, and I was constantly tense and in pain. I have lower back pain, tailbone pain, nerve pain, pain in my hips. I was walking around with a hand grenade in my pelvic bowl, and the only way to keep it from going off was to clench everything as much as possible, at all times.

Obviously, this technique wasn’t working for me.

The first time I met Brittany, the pelvic floor physiotherapist, we just talked. I had come out of two surgeries, blood and iron transfusions, daily injections of blood thinners for six months, countless CT scans with contrast dye, MRIs, chemo, the works. I was sick and tired of being a body.

In fact, on a particularly bad day, I went into Brittany’s exam room, sat down, pulled my feet onto the chair and hugged my legs. I barely looked her in the eye as I sobbed and told her I didn’t want to be touched, I couldn’t bear it.

Brittany gave me distance, and for the bulk of my appointment, we talked about what had happened to me. She gently shared how certain procedures would have had a specific impact on parts of my body. Slowly, I started to be able to see the bigger picture out the box of puzzle pieces I’d been carrying around with me.

Suddenly, my pelvic floor wasn’t just the foundation of the building that is my body – it was the centre around which much of my health and well-being resided. I started to see this netting of muscles as the incredibly resilient, flawlessly designed system it really is. And then I started working with it, instead of treating it like a bomb about to go off.

So, for the uninitiated, here is what a pelvic floor therapy session including internal work looks like.

You go into the appointment and talk about what your concerns are. There are many issues that circle back to the pelvic floor, so don’t be shocked if you mention a sore back, hips, thighs, etc, and come out with pelvic floor exercises.

If you are comfortable that day, your therapist may suggest working with the pelvic floor. She leaves for you to put on a gown and lie down on the table (rather like a massage table). You can let your legs fall open, or pull them back to your chest. You can also lie on your side – the key is being at ease.

A trauma-informed therapist is vital. Mine asks and informs every step of the way. A history of sexual abuse followed by medical trauma can make this uncomfortable or even triggering. I suggest working closely with your physiotherapist on how to navigate that if anything should arise for you. For example, I can stop all therapy just by saying, ‘stop’. It’s not a bad thing, it’s not wasting anyone’s time: it just means I need a moment or may not be able to complete the exam that day. This is an excellent space in which to practise your boundaries. You will not be punished for saying NO here!

While massaging the internal muscles, your physiotherapist will wear gloves and use lubrication. She may use one digit or two. She will be in communication with you, answering any questions that arise or explaining why a particular movement causes discomfort or feels different than another area.

It is strange, at first, until it isn’t. Life is like that.

Brittany gives me a laminated drawing of a pelvis with all its attendant muscles to look at, and she explains which muscles she’s engaging while I find them on the cut-out. This is how I learned about how many pelvic muscles there are, how they wind around our organs, and how easily they can fail due to surgical intervention, or age, or tension.

After a few sessions, I can begin to identify the muscles by feel. After a few more, I can relax and tighten them at will.

And now, I can relax my pelvic floor and cause a sense of peace to radiate through my body. When my pelvic floor is relaxed, a lot of my associated pain backs off – not entirely, not nearly – but just enough to give some relief, and some hope that it doesn’t always have to be like this.

Most women have at least one condition that could be eased or even alleviated by pelvic floor therapy. The tradition has been that we either suffer in silence, or when we do discuss it, it’s with an air of inevitability. Like it’s just part and parcel of being born in a female body with all its foibles. But that’s bullshit. We do not have to suffer.

Now when I’m sitting and watching tv, if I feel tension in my body (always), I start with relaxing my pelvic floor. It feels rather like an unspooling. And of course with almost every movement, it will re-engage. Those muscles are working non-stop to keep you stable and keep your organs organized. When I’m lying on my back, my relaxation always starts in the hips, which is to say, it starts in the pelvis. And if I can get my pelvis to relax, it’s the equivalent of a deep breath. No animal in danger ever had a relaxed pelvis – their muscles would be tense and coiled to support them in fleeing or fighting. Therefore, if my pelvis is relaxed, I am not in danger. And my mind believes my body. Try it.

I don’t know everything about PFT, and of course my sessions will look different than yours. My therapist is a fount of knowledge, though, and I consider it a very good use of my time to ask her questions about my body, my experience of the world. I encourage you to do the same! And if you have any questions for me as a laywoman, I can try to answer them.

My hope is that this post inspired you to take your pelvic floor into consideration, because it is tired of carrying all the weight with so little appreciation!