Making babies: It’s all fun and games until you get a bladder hernia
More than 200,000 women are diagnosed with a cystocele annually. When it happened to me, I went to the Internet to read about other women’s stories and was disappointed. It’s so common, but no one’s talking about it… until now. The following is my experience of being examined and diagnosed by a women’s health physical therapist who specializes in the pelvic floor.
It was a normal Thursday evening. I’d snuck away from my husband and three young children to shower in an empty bathroom; the quiet was rare and appreciated. During my body washing routine, I felt a bulge of tissue between my legs.
My whole body went flush. My stomach had a pang of anxiety. I felt for it again and was not mistaken: something was sticking out of my vagina.
I took some deep breaths, told myself it was probably nothing serious, London Bridge was NOT falling down, I’m not even 30 yet. I’m too young for anything like that. Each of my stringbean babies were under 7 pounds! This just doesn’t add up!
When I got out of the shower, I dried myself off and put my makeup mirror to use — yes. Yes, something was there that should not be there. I was able to push it back in and thought, Problem solved! Crisis averted! Until I took a few steps and out it came.
The next half hour was devoted to consulting Dr. Google, and texting my mom, my best friend, and my homebirth midwife. None had personal experience with this, and all suggested I get it checked out.
I think it’s fair to say that an average woman would be worried about this, but I was terrified. I had vaginismus until I was 23 — long story short, my vagina did not work as intended. Pelvic exams caused full-on panic attacks in the stirrups, a grown woman sobbing and shaking. I know and trust the nurse midwife I called, but I still was full of dread and anxiety. To put icing on the cake, I tore severely during my first baby’s birth and was left with so many stitches, my midwife lost count. I don’t want anyone to see my genitals because they’re covered in scars.
Her exam wasn’t brief, but it gave so much information. I have what are called trigger points, or small, tight spots, inside of my vagina. When she pushed on them, I felt pain there or in other areas of my pelvic region. She assumed the bulge was a cystocele, or bladder hernia, and referred me to a pelvic physical therapist.
A cystocele happens when the muscle between the vagina and the bladder is weakened. It can’t hold the bladder in place anymore, and it essentially flops down, creating a droop in the vaginal canal. So the bulge itself isn’t my bladder, it’s my vaginal wall being pushed because the muscle can’t hold my bladder up. My husband never noticed it, and I only ever did after sex — I just made excuses for the discomfort I felt. I probably just need more lube, there’s probably just a tender part there near the opening, and so on. But at nearly a year postpartum, the tenderness never went away. I felt like my diagnosis was me finally facing the music, addressing my biggest insecurity — my vagina — directly.
I put it out of my mind until the night before my physical therapy appointment. Then, it all hit me at once. Nervous doesn’t begin to describe it. Anxious barely scrapes the surface. I had young children to take care of, a household to run, and I was just wanted to escape myself and my life and my broken vagina. My heart hurt. I couldn’t stop shaking. Not only did I not want an exam, I didn’t want the discussion to turn to my postpartum body.
I’m carrying at least 20 extra pounds these days. I’ve got loose skin, stretch marks, big milk-filled breasts and an equally large butt. I’m honestly 100% okay with this, but my insecurities led me to think the therapist would make an offhand comment about how we can “fix” my tummy, or she’ll help me get my shape back. Seriously, my brain is a terrifying place to be sometimes, and I tend to plan for the absolute worst-case scenario. It was all for naught, because my appointment went extremely well.
After discussing my medical history, the therapist examined me clothes-on. I did all sorts of leg lifts and walked on tip-toes. After, I laid down on the exam table and she pushed on parts of my stomach to feel my abs, and had me do various tasks to see how strong they were. Despite birthing three children in just over 4 years, I didn’t have a separation in my abs. That was one welcome bit of good news! Also, my abs were there and could be contracted, we just have to teach them when they need to do their jobs.
Next came the internal exam.
Since I’d gotten to know my therapist during the appointment, I was strangely okay with her examining me. I knew I had to do it. I couldn’t avoid this problem any longer. There was a sort of empowerment knowing that by consenting to the exam, I was taking charge of my health.
Her actions were similar to what my midwife had done, pressing internally and having me report any tenderness. I flexed my pelvic floor and we learned that the muscles surrounding my vagina have little to no tone. Zing! I needed some ice for that burn. However, the muscles around my butt were super strong because they’ve had to overcompensate.
Fixing the cystocele includes strengthening my abs (they keep my pelvic organs lifted, and we need to get that bladder less affected by gravity), getting tone back into my vagina, and trying to relax the rear portion. We’re going to accomplish this with appointments twice a week, as well as daily homework. I have ab workouts to do — all kinds of leg lifts and the like — and I’m also tasked with my greatest challenge yet: massaging the trigger points in my vagina, either with my hand or a tool she sells at her practice. As a former vaginismus sufferer, this has not been a part of my routine. It doesn’t come naturally to me. It makes me uncomfortable. But I have to do it, so I will. This is about overcoming physical and mental hurdles, and I have to keep my eyes on the prize: sex won’t be painful anymore, I’ll be confident in my body’s ability to keep all of its organs in their proper place, and I won’t need surgical repair later.
Everyone jokes about peeing when you sneeze after you have kids. Women who birth big babies catch all sorts of hell, as if their genitals are damaged forever (they’re not). Jokes about vaginas are totally normalized, but no one discusses the real issues. Maybe you’re not comfortable reaching out to a close friend, your mom, or even your doctor, if you can’t make it to the bathroom in time for a #2 after you have a baby. Maybe you assume uncomfortable sex is just your life now. Peeing when you sneeze? Common, but abnormal and totally fixable.
These are problems. These are embarrassing, not super socially acceptable problems. But gosh dang it, your life as a mother is hard enough. You deserve answers, and help, and kindness. You deserve a strong pelvic floor.