Arachnophobia and the Damp Panties

It's October and my son is obsessed with holiday decorating. We have a Halloween light show set to music currently set up in our front yard and this is just a tiny little warm up for his Christmas spectacular that will be coming soon to the lucky people of our neighborhood....Sorry y'all.

Part of his decor includes a couple of small spiders. Spiders are my number 1 fear in the entire world. I hate them, I can sense them near me, I can't look at them. It's a legitimate phobia and my children think that it's hilarious to hold up a fake tarantula near me and watch my terror. Super fun.

Here's the thing-  lots of women would not only be freaked out by the arachnic near their shoulder but also be freaked out by the fact that screaming and jumping would cause leaking. The case of the damp panties. No one wants to walk around Spirit Halloween in damp panties y'all. No one. And guess what, WE DON'T HAVE TO.

Did you get that? IT'S NEVER NORMAL TO PEE ON YOURSELF.

Even if there's a disgusting hairy fake spider near you and you'd rather curl up and die than have it touching your body. Even then. Not okay to pee.

What causes us to leak urine? 
1. Well, it could be weak pelvic floor muscles. Often, the muscles in our pelvic floor don't do a great job of keeping pressure on the urethra and keeping our pee inside of us. Our urethras are shorter than mens' so there's not as much distance between our bladders and the outside of our bodies unfortunately. The downward pressure of the shriek, cough, jump, sneeze can overcome the muscles and allow pee to squirt out.

2. Sometimes, the muscles are strong but get tired easily. Do you notice that you leak more at the end of the day? Your muscles may have good power, but get fatigued and just can't help you as much at the end of a busy day. This can cause leaking as well!

3. There is also the case of the tight muscles. A big number of us women are actually weak because our muscles are tight. Our muscles are too tense to work well for us, so when we try and use them they just can't get that good power behind them. Plus, when we cough, sneeze, run from a tarantula, the muscles are so tight that they can't let go to help take the load. Think of it like a trampoline. When you land on the trampoline, it gives a little before bouncing you back into the air. This is similar to how it works when you jump or laugh, the pelvic floor has to give a little before activating and lifting back up. If it can't, then you are jumping up and down on a firm floor and you are going to leak.




So, the next time your darling children, neighbor's children, grandchildren, students come at you with a horrifying beast such as a fake arachnid (or snake, frog, ghoul and ghost, whatever makes you recoil in fear), take a minute to think about your panties. Are they damp? If so, you know there's a little something that can use some attention in your pelvic floor!! Kegels may or may NOT be the answer for you and there IS a right way to Kegel, so get the help you need so that next Halloween even the nastiest eight legged creature won't scare the pee out of you!

Fayetteville Pelvic Health & Wellness
Lacy Kells, owner

lacykells@fayettevillepelvichealth.com
910-309-3726


Follow me on Facebook: Lacy Kells PT, DPT
Follow me on Instagram: @lacykellspt

Website coming soon!!
www.fayettevillepelvichealth.com

Cesarean Recovery Before I Knew Better

Six years ago I found out I was pregnant with twins. It was a complete shock and we didn't find out until our anatomy ultrasound halfway through the pregnancy. Because I am how I am, I had a full on panic attack in the ultrasound room because I did NOT want twins. I don't know why, I guess I felt like I had just now crawled out of the depths of depression after my son and now I was going to have to do it again, except with two.

Anyway, my pregnancy was very uneventful. Thankfully, both baby girls were healthy and I didn't have any complications. The only slight issue was that Baby B was breech. She never ended up turning and after lots of consideration, my husband and I opted for a Cesarean delivery. I'd had a vaginal delivery with my son two years earlier and while everything went okay, the recovery was  hard for me. I was depressed, had a pretty gnarly tear, and my kid didn't sleep. I was also not a Pelvic Health PT at that time and didn't know a whole lot about recovery back then. I didn't know much about Cesarean birth or recovery at that time.

Picture then night before our twins were born!

I will say that a scheduled Cesearan felt like a vacation after the labor, fatigue, and complete exhaustion from my first delivery. We'd gotten a night of sleep, were able to get up and putt around the house with our son before heading to the hospital around 10am. The surgery went well and for a good many hours that day I was still nice and numb which meant I could focus on nursing the babies instead of the pain.

However, there wasn't much information for me after the delivery. Not a whole lot of education on what I should expect after this major surgery, how to help my body heal, even what was normal pain versus something to worry about. I was sent home with a cheap belly binder and told to schedule my follow up with my OB for 6 weeks. 



It was a lonely time and sometimes filled with fear. I remember feeling a pain in my belly that I became convinced was nerve related and would never go away. I started catastophizing about how I'd have this pain forever and become depressed and suicidal and never be able to care for my kids. I did call the nurse and she felt like it was okay and sure enough, the pain went away, but those days of fear were exhausting because I just didn't know.

First hour at home two days after Cesarean section.

Now, if we all had Pelvic PTs in our lives, things might look a little different. We would have a good bit more knowledge about what to expect, how to heal, and what's normal and what's not. Here's how things would have been better for me had I known then what I know now:

First of all, I would have been working on proper core activation and breathing long before delivery, Cesarean OR vaginal birth. This would have not only helped my core stay happy, but would have allowed my pelvic floor to move through a nice range of motion in preparation for delivery. I would have immediately started working on this breathing in the hospital bed that first day, certainly before the effects of the spinal wore off so that my belly could get a nice, natural movement and let my pelvic floor come along for the ride also. Not only does this help with relaxation and pain relief but it also promotes healing and a reduction in swelling in the belly and labias. Who knew right? I probably would have done some belly binding (like my friend Melissa at The Fayetteville Doulas showed me recently) that would have helped me move around better, promoted healing, reduced pain). A few weeks later I would have started gentle abdominal massage to promote bowel motility (I tried to stay off the pain meds but just being in the hospital taking them can promote constipation). This could have also helped my abdominal muscles function better, therefore helping my abdominal separation become less of an issue AND helping me lift the babies with less pain and risk of injury to my back (which still bothers me six years later). I would have gotten the go ahead from my doctor around 6 weeks once the scar tissue had healed to begin scar tissue massage. This is gentle massage of the Cesarean scar that helps the tissues move well and reduce the risk of things getting super stuck later on. A Cesarean scar that doesn't allow tissues to move well can actually contribute to low back pain, hip flexor pain, urinary urgency/frequency, continued dysfunction from abdominal separation, pain when you are moving or exercising and more! It's defintely something I would have worked on to help get me moving on the right foot. I would have also had a Pelvic PT do an internal exam to check my pelvic floor muscle function. I would probably at that point have started on some Kegels since I wouldn't have had pelvic floor tension and this would have greatly helped my back pain and my leaking over the last few years.

Alas, I didn't have one in my life at the time so it's been a lot of years of dysfunction that have made it a lot harder to deal with now. I hate that women aren't getting the education we deserve, the preparation we desperately need before childbirth and in the postpartum periods. I do think things are getting better. In the past year I've met several amazing doulas in town who share the passion for educating women that I do and they are doing great things. I have met women who have been fortunate enough to have seen a Pelvic PT and are so excited for all the knowledge they had going into their births. I have colleagues in town working their tails off to make women's experiences better and so many on social media who are doing the brave thing and putting this information out there into the universe. However, I think we have a ways to go. We still need to talk about birth more openly, about recovery and our experiences with less embarrassment and shame. There is NOTHING shameful about childbirth - and when I say childbirth let me make it clear that no matter how that baby comes out, it's birth. Cesearean section or vaginal birth is all still birth. There is nothing shameful about recovering from up to 9 months of difficult physical exertion (growing a human being in our body) and then going through a birth. It's no joke and it's not easy and it's okay to have to take a long time to heal and recover.  What's NOT okay is the lack of knowlege moms have going through all of this.

My hubby with our baby girls.
This was one of their favoritate places
to sleep! 

Please, tell your loved ones that there is so much more out there for them. Find a doula and start asking questions, ask your provider for information, or find a Pelvic PT in your area to help get you started. I offer monthly Birth Body classes where we talk about how to prepare your body for labor and delivery and how to start your healing process just hours after you give birth in a safe and healthy way. We talk about how to start using your abdominals and pelvic floor after birth in ways you can work on while you are breastfeeding, rocking, playing with baby. We talk about what's normal and what's not and when to ask for help. I'm not writing this blog to promote this class though, I'm writing it to continue to try and spread awareness for women, specifically mommas this time, that there is SO much we don't know that we really ought to know. Let's continue to demand better for ourselves, get the education we deserve, and become healtier moms for our babies!

Lacy

Fayetteville Pelvic Health & Wellness
Lacy Kells, owner

lacykells@fayettevillepelvichealth.com
910-309-3726


Follow me on Facebook: Lacy Kells PT, DPT
Follow me on Instagram: @lacykellspt

Fireworks

If you have never experienced pelvic pain, it's hard to imagine that sex can sometimes be a pain, literally. The prevalence of pelvic pain tends to depend on which study you find or what area of the world you are researching, but chances are at least one of you in your friend group (probably more) has had pelvic pain at some point in their lives. Sometimes this pain can manifest as pain with intercourse.

There are a number of things that can lead to painful sex, but know that it's never normal to experience pain with intercourse. There are a lot of myths out there - things like "it hurts because you are getting older" or "it's probably just because you need to keep trying" or "you aren't relaxed enough, have some wine."

I'm just going to throw this out there: those are bullshit things to say to a woman who hurts with sex. If you have pain with sex, you've not experienced good sex, normal sex, certainly not "fireworks." None of those myths make sense to a woman with pelvic pain.

Here's the thing: It's never normal to have pain with sex. Common, yes, normal, no.

One obstacle women often encounter is that upon GYN exam, everything may look okay. GYNs are typically trained to look for the scary stuff, things like cancer or major prolapse, anatomical abnormalities... big picture stuff. What they sometimes don't get a chance to assess is the muscles, tendons, movement patterns, sensation... things that PTs are experts in looking at. That's the beauty of my job. I get to look at all of that and try and get to the bottom of the issue, often after a woman has been through tests to rule out the "scary stuff."

Pelvic pain during sex can come from a number of issues. There are too many to get into in one blog, but let's talk about some of the biggies.

1. Spasms or tension in muscles: This is one of the most common causes of pain that I treat as a PT. The pelvic floor is made of muscles and the vagina is supported and surrounded by these muscles. If the muscles are tight, stretching them can be painful. If you attempt vaginal penetration, it's going to hurt. Sometimes penetration isn't even possible because the muscles are so tight or spasmed. So many patients ask "Why." Really, it's hard to say. Neurologic issues, anxiety/depression, trauma, adverse childhood experiences, or even something like injury to a seemingly unrelated area can lead to pelvic floor tension. Unfortunately, this tension can lead to plenty of other issues besides pain with sex. Leaking, constipation, pain with sitting/tampons/GYN exams, etc. The good news is that there are lots of tools in our toolbox to work on this. Typically we discuss the big picture - diet, exercise, mental health, breathing... It needs to be a holistic approach.

2. Nerves: You have a lot of nerves running through your pelvis. Sometimes there are issues with the nerves coming from your spine or sacrum. Sometimes the nerves within the pelvis can have issues (getting pinched or irritated). This often involves muscle tension as well, so treatment for this is not remarkably different than muscle tension. It's still a big picture look at everything going on so that we can improve movement and reduce tension and irritation of the nerves.

3. Inflammation: Some women feel pain ONLY on the outside. For me, it was right at the vaginal opening. Sometimes it's the entire vulva. This can lead to muscle tension and further pain, leading to a cycle of pain and more inflammation. This can sometimes keep women from not only being able to have sex, but even from wearing underwear or tight pants. Again, this is something that we address holistically, looking at the whole system and working with physicians to help calm down the inflammation and get things working better.

4. Endometriosis/IBS/other medical issues: Sometimes pain with intercourse may be a result of issues that aren't directly muscle related. Conditions like endometriosis, IBS, even dysfunction in the low back can refer pain to the pelvis and make sex difficult due to pain. These are not treated solely by PTs but instead require lots of communication between PT, GYN, urogyn, neuro, GI, etc. As PTs, we can contribute a good bit to the treatment of these conditions through extensive education, improving things like pelvic floor motion, abdominal strength, motion, etc. Very often muscle tension can be a factor associated with these conditions as well.

This is certainly a much oversimplified version of pelvic pain. Things like vaginal dryness, hormones, positioning, emotional wellbeing, orthopedic concerns can all play a role in pelvic pain. It's almost never simple. The pelvis is complex. There are a lot of muscles that attach the pelvis and a lot of systems that sit within it. It is often called the "root" or center of our energy in the body. It's hugely important, so when things are a little off, it's not usually just a quick fix. However, as a PT my job is to take a step back and assess the entire picture. Looking at the pelvic floor muscles, nerves, the low back, the muscles surrounding the pelvis is just the start. Looking at how a person breaths, moves, bends, lifts, sits, stands, sqauts is just another step in putting together the puzzle. It's complex, but it's essential to get to the bottom of things. Get it, bottom??

When a woman has pain with sex, it's awful. It's an emotional nightmare, a physical nightmare. It burdens the woman with guilt, shame, fear, worry. It burdens a relationship with the same issues. I have known women who have had relationships end because of this. It's ugly and awful to carry. No one talks about it, no one knows what to say, and often "everything looks okay."

We can do better than this. We can give women hope. If you, a loved one, your spouse, your friend, anyone you know has pain with intercourse, please tell them there's hope. Tell them about physical therapy. Tell them to find someone to look further. Tell them to speak up, demand to be heard, demand better for themselves. Pain with sex is never normal. Get the help you deserve. Bring the fireworks back to your sex life y'all. It may not be an easy journey, but it will be very worth it.




Lacy Kells PT, DPT
Owner of Fayetteville Pelvic Health & Wellness
lacykells@fayettevillepelvichealth.com


Follow me on Facebook: Lacy Kells PT, DPT or
Instagram @lacykellspt

www.fayettevillepelvichealth.com

Pregnancy, Postpartum, and Physical Therapy

I have been blessed to be pregnant twice. Once with a son and a second time with twin daughters. While I was so incredibly thankful to be expecting healthy babies, I did NOT enjoy pregnancy. I wasn't one of the glowing pregnant women who walked around basking in her own glory. I was the one over the toilet every day for months, the one turning green at work and trying not to vomit on my coworkers as I sprinted past them to the bathroom. The woman lying in the bed whining and sleeping half the day getting nothing done because my body just couldn't take another minute of being up and moving.

35 weeks with my son (1st pregnancy)

I tried to stay active during my pregnancies, but after being so sick for the first trimester it was hard to do much once I felt better. Then, in the third trimester, I hurt everywhere. My entire body felt like it was sore 24/7. Getting out of bed was a huge challenge. Using the bathroom was a test of my endurance since at some point one must stand back up off the commode. Even trying to wipe was a bit of a struggle because I was so stiff through my entire spine that twisting was hard. (Sorry y'all, but I'm not embarrassed to share). My back hurt, my neck hurt, my hips hurt, I had shooting shock-like pains in my pelvis from nerves being pinched. It was not pleasant. I was not a nice person to be around. 

Back then, I wasn't practicing Pelvic Health. I was toying around with the idea in my head, knowing I wanted to do it some day but was preoccupied with my own babies. I hadn't yet taken the OB classes for physical therapists so I didn't know much about how to help myself other than some yoga (which was really the only thing that helped me keep going!). 

28 weeks pregnant with twin girls 

Nowadays I know so much more. I have taken classes on what PTs can offer during pregnancy, I have had clinical experience working with pregnant women and helping them through their pregnancies. I have read and asked and learned since those days. Unfortunately, I don't think that most women have any idea that they don't have to suffer through a pregnancy feeling miserable. Quite honestly, I never once complained to my OB about my aches and pains, knowing that the docs would probably shrug their shoulders and tell me it's just part of pregnancy. The sad thing is that this is not how it has to be.

Our bodies go through an incredible journey during pregnancy and every week things in our bodies change, but that doesn't mean that you have to "suck it up" and suffer. There are often small and easy things to do to help reduce pain. Certainly there are ways to keep your body moving well and prevent pain as your pregnancy progresses. Often, I see pregnant mommas weekly to keep them moving, work out some of the new pains they may have, get rid of other pains and keep them from returning. We talk about labor positions that are best for their condition (did you know that certain positions during labor and delivery are better if you've suffered from back pain in the past, or pubic pain, or hip pain, etc...??). We go over exercises to keep things working well for the remainder of the pregnancy. We talk about perineal massage to get the pelvic floor ready for birth. We talk about pelvic floor relaxation and strengthening to prep for delivery. We talk about postpartum healing that lets women start on the right foot from the moment they head to the postpartum ward. There is so much education I never had as a pregnant mom or a new mom that I would love to have known 7 years ago. So much I would have done differently for my mind and body. I was fortunate to have yoga to help get me through, but even so I would have loved to have had someone to help me feel better during those months. A pregnancy is such a short time in a woman's life really, but the effects of it can last forever if you don't know how to take care of yourself.


Regrettably in the US, many women aren't educated on how to care for themselves, either during pregnancy or in the days, months, years after. I definitely wasn't. It's incredibly frustrating as a PT who can help women have pain-free (or at least less painful) pregnancies and better postpartum experiences. As a woman and mother, it's infuriating. It's not fair that we are told that pain is "just part of the experience." That we are left to recover from vaginal tearing or Cesarean birth with little more than an ice pack or a hospital issued binder. We are expected to head home and continue on with life without complaint, without help, certainly without showing any weakness. This is completely and utterly unreasonable and unacceptable. We could do SO MUCH better.

Very pregnant with twins - I think only a couple of weeks away
from being a family of 5 here. 

PT during pregnancy can be a game changer. It can keep you moving, active, able to care for other kids or stay at work, manage weight gain or heart health, and keep your body in shape to have an easier labor. Not only that, but it's a great resource for birth prep and recovery. I have many local friends doing amazing things for women that I often recommend to my clients. I see this as another bonus to having a PT during pregnancy- these links to some amazing doulas (for both labor support and postpartum care), lactation consultants, nutrition counselors, mental health professionals, local mom groups, and places to exercise with childcare or awareness of good postpartum health.

As women, we often put ourselves last. We sometimes let our physical issues fall by the wayside only to catch up with us years later. If we were educated during the years of pregnancy and immediate postpartum time periods we could avoid a good bit of this down the road. If our healthcare system was more proactive, more preventative, we could all be the superheroes that we already are, but without pain or leaking urine or constipation or back issues. Very often it feels as if the system is broken, but as women we are powerful. We are amazing. We can work to help each other know better. And when we know better we do better. No more suffering through pregnancy and postpartum. Find a local Pelvic Health PT to help you and expect better! Get it, expect better?? Well, I for one think it's clever. Please share the message, spread the word to your friends and family. Let's change the game y'all!








Lacy Kells PT, DPT
Owner of Fayetteville Pelvic Health & Wellness
lacykells@fayettevillepelvichealth.com


Follow me on Facebook: Lacy Kells PT, DPT or
Instagram @lacykellspt

www.fayettevillepelvichealth.com

Offereing boutique-style specialty Physical Therapy for men and women of Fayetteville, NC. 

Leap High

A long, long time ago I was a ballerina. Nothing professional, but I loved it and I was decent at it, and every time I would get home from class my Dad would ask me the same question-
"Did you leap high?"

NOT ME doing a Grande jete. This is my
favorite Carolina Ballet Principal ballerina
Margaret Severin-Hansen,
an actual professional doing a proper leap. :) 

Grande jetes (big leaps) were my very favorite. Hurling myself into the air (gracefully of course) was easy for me. I remember doing it with total abandon yet a good bit of control. My ballet teacher even made me the donkey in Carnival of the Animals because the donkey's dance was basically just insane hopping all over the stage. When I got my driver's license my Mom and I secretly ordered a vanity plate for my car that said LEAPHIGH and surprised my dad with it. Now that I have kids I realize it was mostly for all of their friends to be able to keep tabs on me around town, but still, it was special and I had it for years.

At my wedding, my Dad walked me down the aisle. When it was time to officially "give me away" he whispered in my ear, "Leap high." It was exactly the right thing to say.


Years later, that careless sense of leaping has been replaced by complete fear of the unknown, of where I may land if I were to jump, of falling when I hit the ground. Adulthood and motherhood have broken me down and have brought my anxiety to the forefront of a lot of decisions, because safety and security just make more sense when you have three kids.

However, when my Nana died a year and a half ago, my world seemed to fall apart and a lot has changed inside of me since then. I don't think I fully grasped what it would be like not to have her in my life after 34 years. I was very depressed, struggling every day to get it together. Slowly I began to question a lot of things in my life. I thought more about what made me the way I was, what I wanted to improve on, how deeply my sense of self worth was broken and why that was, not having experienced anything that could lead to that. Working through a lot of these issues sort of rocked my world. I started to become angry at myself for being so scared all the time. Scared of failure, scared of what other people think of me. I don't want my girls to live with that fear, but if I am their example, how can they not pick up on it?

So, that brings me to the here and now. After almost a year of soul searching, prayer, agony, fear, tears, hope, and more agony, I am leaping. I am taking a big jump for the first time in a long time into the unknown. I am leaving a job that I have had for 10 years and I am going out on my own. I am leaving a place that gave me my first job out of PT school, with a boss who taught me how to be a good PT and allowed me to pursue my dreams of practicing pelvic health. Leaving the place that let me have three babies and work when I could, always giving me support and never judging me for choosing motherhood as my top priority. A place where I could decorate my room with plants and pictures and even a pretty little needlepoint vulva that my best friend gave me for Christmas. (Sidenote: That's true love right there by the way. Stitching your friend a pretty vulva for her clinic room = love.)

I am walking away from Advanced Physical Therapy Solutions and leaping headfirst into what I am calling Fayetteville Pelvic Health. I don't know exactly what it's going to look like yet. I am not sure how it will evolve. I know that I want to continue to serve men and women of my beloved hometown, but I want to do it in a way that looks a little different from the traditional model. I am working a lot of the details out now. There is still a lot up in the air, lots that makes me anxious, but I'm not letting myself live in fear of the unknown anymore. I may fail. I may fall. I will most definitely have some stumbles, but if I don't try I'll never know what I'm capable of. Everyone at APTS has been incredible, supportive, excited for me. In some ways it makes it harder to step away. These people are the cream of the crop. Literally the best PTs around, hands down. Incredibly smart, outside of the box thinkers who never settle for mediocre and are always learning. It's truly a dream job working with such highly skilled therapists. It certainly made me a better PT every day that I came to work and learned from my colleagues. It's going to be lonely and scary not having them to help me, but I want my kids to watch me leap and watch me stumble and then watch me get back up to accomplish something that is on my heart. I want them to know that sometimes doing the scarier thing is okay and that failure does not define them, or me. Perfectionism has kept me living in my safe zone all my life, and I'm sick of it. I am not perfect and I don't have to be.

So here I go. I'm leaping I hope I still have just enough grace to land on my feet. But I am realizing that even if I fall, I'll be okay. I can get up and keep dancing.

Stay tuned for more information on Fayetteville Pelvic Health - coming soon in May!!

The Marathon and the Urine Shoes

Catchy title isn't it? Sadly it is an accurate description of myself and my shoes following my first marathon a few years ago. I ran my first marathon on January 10, 2016 at Walt Disney World. My twins were two and my son was four. Our parents kept them for us so my husband and I could head down just the two of us. It was a great getaway despite 26.2 miles of heat and humidity. And the urine shoes. Cause I mean, urine shoes aren't the most romantic addition to a weekend without the kids.

Stopping for a photo in front of the castle! 

Training for a marathon with three children aged 4 and under is easy. I truthfully couldn't dedicate the time that I now know is essential. Not only that, but eating well is hit or miss as a mom of young kids and my diet was not the least bit appropriate for marathon training. However, I needed to do something to show myself how far I had come since the days of having twin infants. I needed a goal that didn't involve feeding children or kissing boo boos. I hated running at the time but I also knew it was something I could do easily without spending much money and without having to drive anywhere for a class. Plus, my husband and brother in law had started running marathons and since I am a competitive Type A woman, I couldn't accept being outdone by two boys who had never grown a human in their bodies. No offense men, I'm just sayin. So off I went on my crusade to become a runner.

If you know me at all you'll know that one of my biggest soapbox topics is postpartum care in the US. It's totally unacceptable in many cases. I am a Pelvic Health PT, so I know better, but most women get NO instruction on their postpartum bodies. Because I'm a PT I am also the worst kind of patient. I'm non-compliant and totally lazy, unlike most of my patients who actually do their homework. I didn't do much of anything to prepare for running besides, well, running. I had some pain in my buttocks here and there and some incontinence during my training but honestly, I just didn't care.  I think I had struggled so much with stress and postpartum depression over the past few years that peeing on myself didn't seem like a big deal compared to taking care of kids.

On race day at Disney it was muggy and hot and we had been up for hours in order to get the starting line on time. We had walked a long way from the shuttle to the corral and adrenaline had been flooding through me all morning - not really ideal for my body which is typically already full of stress chemicals. By mile 7 I was losing control of my bladder. Whenever I would slow down to walk (which was VERY often) I would leak urine. By mile 9 or 10  I was already uncontrollably peeing on myself. The benefit there is no porta john lines, but still.

I struggled to get through the race. I was SO hot and had 11 blisters on my feet. I was soaking wet from sweat and pee. The high of crossing the finish line was unreal, despite my urine shoes. But the fact is that I should never have been at the point where I was just peeing on myself for miles and miles. It's not the least bit normal or okay.

For my second marathon, the Outer Banks Marathon, I trained smarter and ran solo. I ate better and made time for Yoga. I tried working on my abdominal, hip, and back strength. I PR'ed this race and felt amazing through it. Then came my third.

Outer Banks!

I don't know why I wanted to do another one. I suppose many runners can attest to that need to prove yourself faster. I ran the Wrightsville Beach Marathon this past March because it's close to home and we have a beach house nearby. I stuck to my training schedule, ate well, but even so my body just wasn't feeling it. I had major pain in my buttocks and down my legs every time I ran. My back ached literally all the time. I couldn't walk in the mornings when I first got up so I sort of threw myself forward into the bathroom holding onto the walls until a hot shower helped me stand up straight. I ran the race in pain. Major pain. Annoyingly enough, at first it wasn't even my "normal pain." I had put a tampon in that morning (because nothing is more awesome when you are trying to run 26.2 miles than menstruating at the same time) and within the first two miles I was having rectal pain. Yes, literally pain in my butt. I knew why - I'm a Pelvic Health PT and all - so I knew my pelvic floor muscles were tightening because they didn't like the tampon in there at that moment. Nevertheless, I persisted. At mile 7 I stopped at a toilet and yanked it out, texting Ashley (my PT Best Friend) cuss words and whines about my pelvic floor woes. The good news is that the rectal pain went away when I took out my tampon. The bad news is that my back and leg pain presented itself immediately because now my brain could feel it since my bum was happier. Hurray.

I almost quit this race. My daughter had started vomiting at 3am the night before, our car broke down, and there was a chance my family wasn't going to make it to the finish line. I was over it, but I had a college friend who was biking to various points along the route cheering for me which pulled me through. The pain was excruciating and basically debilitating and I cried a few times toward mile 20 because it was awful, even with me popping Tylenol during the run. I crossed the finish line only 15 minutes behind my PR which was super surprising to me. Even so, I could hardly move for three full days, something that isn't normal even after a marathon, at least not if your body is working well. My brother in law pointed out after the race that I actually ran it injured, and that was the first ever time I had ever thought of it that way. I was injured.

Wrightsville Beach Marathon

I have run maybe a couple of miles a handful of times since that race but there is pain. I am 5 years postpartum from my youngest babies and the lack of care of my body has finally caught up to me. It took some time for my diastasis to cause me problems (for more about my Diastasis read this blog post), for my pelvic floor weakness to cause pain, but now here I am - fairly broken because of some of my postpartum issues even though I am years past my delivery. My Cesarean scar still needs some TLC, my abdominals need retraining, my pelvic floor is still very weak. Had I done something for myself after my twins were born I can almost guarantee I would not have peed for an entire marathon all the way down into my shoes. I can pretty much assume I would be running my fourth marathon soon. Instead I am feeling more dysfunctional with every week that passes. I am on my friend Ashley's schedule at the end of the month to get some PT of my own. I am going to spend some time diligently trying to get my body back into a functional place. It's going to take some time, but I love the idea of running a few more marathons. I want to run a big city one like Chicago or NYC. I want to run one when I turn 40. I want to show my girls that our bodies do incredible things and that hard work pays off.

Me and my father in law at the finish line of the Ft. Bragg 10-Miler last year. 

If PT were the standard of care following childbirth (which let's be honest, is MUCH HARDER on our bodies than running a marathon), I would be in a better place. I am so excited when new moms take it upon themselves to come in for PT in the early postpartum time frame. They are so much ahead of the game. They understand how to move well, how to work out safely, how to keep themselves healthy. They prevent this gradual breaking down of the body that I am dealing with at the moment. I knew better, but I didn't take the time. It's easier not to. I'm paying for it now, but I'll be okay. I am going to take it slow and figure some things out. I am going to take some time to allow my body to move well again. My body is very different than it was before I had children, and I am totally okay with that. However, I need to learn to use this new and beautiful body well. I am excited to see what Ashley helps me find that needs work and to see if I can get things working better. It's definitely nice having a best friend who also does what I do and can get me back to running. I can't wait to hit the pavement again for something more than a short painful jaunt around the block. Ladies, mothers: we don't have to live this way. We can change how postpartum care is delivered in our country if we would just talk about this. Share this with your girlfriends, your daughters. Tell them there is help and hope and something so much cheaper than having to buy new shoes every time you run. Don't go squishing around in urine shoes like me. Find a PT and give your body the gift of moving well.

Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions
910-423-5350
lacy.kells@aptsnc.com

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt

Why You Should Be Discussing Your Vagina Tears With All Your Friends Right Now.

I'm stepping up onto my soapbox because, y'all, I'm so sick of this crap. I only work a couple of days a week but nearly every week I see a woman who is postpartum and is shocked that her pain or her leaking isn't normal. IT'S NOT NORMAL. I'm not mad at you guys, I'm just mad at the state of our postpartum care. I will say that I read through the new guidelines put out by the American College of Obstetricians and Gynecologists and they sound great, in theory. But I'll also say that just last week I had a patient come in to see me in the morning before heading to her OB's office for her last follow up after childbirth. She sent me a message that afternoon saying that her OB told her that her pain and leaking were normal because "oh, of course, you just had a baby." Then sent her on her way.

Eye roll, mad face, eye roll, heavy sigh, irritated growl. If you know me you know exactly what those faces look like. I have no poker face and I don't hide my emotions well.

When I gave birth to my son, my first baby, I tore. Down below is a graphic illustration of perineal tearing with childbirth. I'm putting this in your face because we need to be aware of this and open to discussion with our loved ones. Or strangers. I have more discussions than you'd think with strangers about this thanks to the power of social media and it makes me so happy. I love meeting a stranger and immediately discussing their vagina. It means that we are breaking down some walls, at least here in Fayetteville.

Day 2 after our son was born, feeling rougher than I looked.

So anyway, at the time my son was born I was only dabbling in pelvic health physical therapy and I had only taken one of the three main courses, so I was very green. I was also exceptionally exhausted. I didn't know enough at the time to ask my physician about the degree of my tear. I remember her saying a few times that I was going to be sore because it was a "pretty good tear." In addition to being exhausted I am almost positive I had postpartum depression the entire year after his birth, so again, I didn't think twice about any of it. The tear had to be cauterized three times over the next few months before it fully healed but I was too tired to care. My MD asked me how sex was and I never told her that there was no way in hell either of us were remotely alert enough to even begin the process of that. She just assumed and I let her, I was probably embarrassed to tell her we hadn't done that since the baby but I can't remember. I knew nothing back then y'all. Not about pelvic health, or motherhood.


Years later I went back to work and devoted by time at work to pelvic health patients. Around that time that my friend gave birth to her son. I was accidentally present for his birth, something we hadn't discussed, but she was induced with pitocin and honestly I thought it would take forever, so I went to the hospital to sit for a couple of hours and no joke it was suddenly 8am and he was on his way any second. So I hid in this little closet with the sink in it in the delivery room because I was pretty sure I wasn't supposed to be there for the birth. Oops. I stayed long enough to snap some photos and ask her doc how badly she had torn.

Me (as a Pelvic Health PT): "Did she tear?"
Doctor: "Yes."
Me: (as a knowledgeable pelvic health PT): "How bad was it?"
Doctor: "Yes."
Me: (as a knowledgeable pelvic health Doctor of Physical Therapy): .....

Eye roll, mad face, eye roll, heavy sigh, irritated growl to myself. Look, when your friend has a baby and is enjoying the moment, you don't make a scene. I kept my mouth shut and just sat there updating her family with photos, then drove her husband's truck into a concrete post in the parking deck on my way to get her other car with the baby's car seat in it. Once again, oops. In my defense, that parking deck is a bear and also his truck is like a flipping tank. Also they knew I am not a great driver when they gave me the keys so...

Image from the University of Sydney: http://sydney.edu.au/medicine/nepean/research/obstetrics/pelvic-floor-assessment/English/sydney%20pelvic%20floor%20body/After%20Birth/Anal%20Sphincter%20Muscle/Anal%20Sphincter%20Muscle%20html.html

Anyway, at her follow up appointments with the physician he didn't once mention her tear, her recovery, her emotional status, her continence, her pain, sex, NOTHING. I wasn't surprised because this physician had made me cry ugly tears during a difficulty period in my nursing of my TWIN BABIES. Which, umm, may sound totally easy to a man who doesn't lactate or birth babies, but nursing two babies is the opposite of easy thankyouverymuch. Anyway, thankfully a couple of years later she was ready for us to work on her incontinence issues because that's what friends are for after all. She's good now, but if she didn't have me going into my tiny fits of rage and explaining what is normal, what's right, what's good care, what's going to happen after birth, she'd have been like the majority of women out there who have NO idea what is normal.

9 years at APTS where I have been able to develop
a Pelvic Health practice over the past 4 years. 

Now thankfully, many women do have doulas or PTs or friends or midwives/physicians who understand that we need to do better in our country when it comes to the postpartum period. Many of them get great care. I do realize that, but I also see first hand that most women aren't getting that. And it's just not okay. In France, Pelvic Health PT is the STANDARD OF CARE. As in, you have a baby, you go to your pelvic PT for a few visits (or more depending), but you always go. It's like the norm there. In the US, most women don't have a clue about what we are, what we do, or how to get to us and frankly don't end up begging for a referral until years later when they have suffered for years. That's unacceptable. It makes me super mad and frustrated. My patients who have come in to see me soon after birth tell me all the time that they are the only ones out of their girlfriends who don't have issues. Guess why. Because we teach them how to re-learn the right way to use their body, their muscles, their pelvic floor right away before things get worse. We start using the correct abdominal muscles, get the pelvic floor working well, take care of scar tissue early so it doesn't become a problem, we nip the painful intercourse in the bud right away before things progress to marital distress. It's the right thing to do after birth. Birth isn't easy and no matter vaginal birth or Cesarean birth, it's hard on the body. It creates changes in the body that aren't necessarily bad, but warrant a couple of visits with someone who knows what your body needs and deserves after birth.

In my last Facebook video I begged people to spread the word. I'll say it again. Please, please, pretty please talk about this with your friends, family, colleagues, strangers you meet at the next wedding you go to. It's too important to keep it all taboo. There is someone in your world who is suffering right now from leaking so much they can't work out and they feel depressed over what their body has become. Someone whose marriage is suffering because she can't have sex with her partner because it hurts too much. Someone who can't play outside with her kids because her back or pelvis hurts too much. You could change someone's life by talking about what's normal and what's not normal. I'm not being dramatic. This is what I do, I see it all the time. It can be life changing. Please help me make this stuff okay to talk about it at book club. Or at girl's night. Or even your next dinner party. I don't care when you discuss it, but discuss it. We all have pelvic floors. We all have some issues going on down there at one time or another. So let's help each other. Tell your people that LEAKING IS NEVER NORMAL, SEX SHOULD NEVER HURT, and there is help for it. Here's my latest video if you haven't seen it on Facebook yet. 

End rant. Happy face, clapping hands, little dance. Thanks y'all.

Here are the updated guidelines for postpartum care:
https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care



Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions
910-423-5350
lacy.kells@aptsnc.com

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt