At Capacity

May 25, 2020 marked one year since I had my miscarriage. The weeks leading up to it were heavy, remembering every day that I was pregnant a year ago. I felt it all.

May 25, 2020 is also the day that George Floyd was murdered by a white police officer. I came out of my own grief to read the news and see social media flooded with petitions and protests and the uprising.

I didn’t feel like I had capacity for it. I told my therapist that week that I didn’t have the capacity to do anti-racism work in the wake of my own grief, in this time of my life.

She challenged me.

She told me I always have capacity, but that I have to choose when and where to shift my capacity.

I have thought of this every day since then. I would always rather be busy than bored, so I fill every spare second of time and add projects whenever there is an ounce of space—like a vacuum.

So, I shifted. I dropped a couple work projects that have been taking up space and energy. I started my own education on anti-racism work, like I mentioned in last week’s post. I held and felt my own grief, then made space to hold the collective grief as well. I didn’t deny my own experience, rather tried to integrate it.

Maybe when we make space for collective grief, the Collective actually picks up some of our own. We all carry each other.

How have you shifted? What do you do when you feel like you’re at capacity? I realize my privilege in being able to shift. As a white person I have the privilege to not do the work of anti-racism. I have the option to turn away. I acknowledge that not everyone has that option. And we all have capacities. We all get to make some choice of where to shift our capacity.

What are you making space for right now? Is it doing this work too? Is it shifting to make time for yourself by asking your partner to watch the baby so you can take a bath? Is it intentionally sitting with your kid without multi-tasking on your phone? Maybe it’s turning off social media so you can write or journal or meditate or walk or just sit and stare at the sky.

When you feel like you’re at capacity, ask yourself:

Where can I shift?

What can I let go of?

What is the most important thing right now?

Make space for it.

Black Lives Matter

Recent events—the murders of George Floyd, Breonna Taylor, Ahmaud Arbery, and Manuel Ellis, here in Tacoma—have led to an uprising of protests and revolution. Many of us are waking up for the first time to really see the ways our country does not provide “liberty and justice for all.”

I am a white woman and am in no way a leader in this fight for racial equity. I am actually quite late to it. But I’m listening, and I’m learning, and I’m speaking out. I’m sharing a list of resources I’ve come across and am learning from, and will continue to build this as I go.

Learn from black people. Don’t ask them to teach you—there are plenty out there doing the work already—pay them for it. Some of the links below are for paid resources, and they are worth paying for. I have no affiliation with them and get no money myself. These are voices that I trust and that I’m listening to.

Local:

List of Black-owned businesses in Tacoma

Donate money or time:

Tacoma Urban League

Washington Therapy Fund

Online:

Unpacking White Feminism by Rachel Cargle

Anti-Racism for Wellness Professionals with Chrissy King

Anti-Racism & Allyship for Rehab  and Movement Professionals with Dr. Jennifer Hutton

Dear White People on Netflix

Follow:

@rachelcargle

@kimberlecrenshaw

@_wholebodypregnancy_

@iamchrissyking

Read:

How to Be An Antiracist by Ibram X. Kendi

Antiracist Baby by Ibram X. Kendi

White Fragility by Robin DiAngelo, PhD

Listen:

1619 - A podcast from NY Times about the history of slavery

On Being podcast interviewing Resmaa Menakem

Watch:

I Am Not Your Negro

Dear White People

Product Review: The Diva Cup

I was always a pad-and-tampon kinda girl until a few years ago. In 2015 my husband and I decided to do part of the Camino de Santiago in Spain, which meant we were going to be walking for 5 days, carrying everything we brought with us on our backs.

Of course, you know the timing of the trip lined up with when I expected my period. Of course.

The last thing I wanted was to pack a box of tampons just-in-case and take up precious space and weight. Especially considering the fact that my bleed was still pretty unpredictable at that time, so it stood the chance that I wouldn’t need it at all.

These were the circumstances that led me to finally try a menstrual cup. Back then (ok it wasn’t that long ago) the Diva Cup was the only product on the market—but if you search “menstrual cup” today you’ll find all sorts of makes and models!

I bought it a few months early so that I wasn’t testing it out on the road, and gave it a couple cycle’s practice. Here’s my review, including things I learned and how it best serves me now:

Pros:

• Reusable/less waste

• You can wear it up to 12 hours on a light day

•  More comfortable than tampons, especially on a light day

Cons:

• Murder factor is high when removing it

• Makes my cramps worse

• Challenging to get in and out, especially if it pops open when you’re not ready for it...

• Leaks on heavy days

• The stem can be poky*

Overall, it has become something I would wear if I wanted to go for a swim or take a bath, or if it was a light day and I didn’t want to worry about changing pads. Though I always wear a pad for backup, because it usually leaks on me when it gets full.

Couple things to note:

• Flip it inside out if the tip bothers you (this was a game changer for me!)

• Make sure it seals around your cervix by squeezing the air out of it

• Bear down gently if you have a high cervix and have a hard time getting it out

• Check out the videos here for help with insertion!

In summary, this isn’t my fave right now, but it served me well for a few years. It might be good for you if you have light flow and a higher cervix, and aren’t afraid of getting all up in there!

On Mother’s Day

Motherhood takes so many forms. Why am I stuck on feeling like I need to carry and birth my own child naturally to be fully known as woman and mother?

In the course of one week this winter I talked with several women on different paths.

One was totally into the thought of being a mother, but not at all interested in carrying her own; we discussed surrogacy.

Another was waiting for her partner to say they were ready to foster-adopt.

A third was single and considering foster-adoption as well.

Then another was navigating the ups and downs of life with a newborn, who was conceived via IUI with donor sperm.

All this was while I was preparing to start IVF, and still grieving the fact that I hadn’t been able to conceive on my own, after 6 years of trying.

Not one of those women were talking about becoming a mother the way I envisioned that I needed to. Maybe there isn’t anything wrong with me. Maybe the point isn’t how you come to it. Maybe the point isn’t even holding my child. Maybe it’s more about knowing that I am already a woman, I am already complete, though always and forevermore becoming.

Motherhood is all of these things.

I am a mother, though I’ll never meet the child I carried.

I have birthed a business, and too many creative endeavors to count. I am constantly creating. It is not the same as pregnancy and raising a child, but it is the same energy that I put forth into the world. It is still beautiful.

There is no guarantee that IVF will result in a child in my arms, but I know already that I am fully Woman, and forever a Mother. I’ve done a lot of work to get to that point of knowing.

I’m not done with that work.

If you’re in the midst of that work yourself, I see you. It’s hard. But it’s worth it.

Motherhood looks like so many different things. All beautiful. All right.

What does it look like for you?

Happy Mother’s Day to all of you, in all your beautiful forms.

How to Be in Your Body

Where do you feel stress in your body? Stop for a moment, close your eyes, and just feel. What sensations are present? Where do you feel the fear, the grief, the loss?

Do you feel it at all?

Coping mechanisms are often simply numbing behaviors. The pandemic is a collective loss—we are all grieving canceled trips, birthday parties, and hugs. We have all lost so much in the past few weeks. And if we sit still long enough, we will feel that loss. And it won’t be comfortable.

So we numb. We binge Netflix. We eat Doritos for dinner. We have a couple more glasses of wine than usual. Or at least this is my list.

I mean—and feel—no shame in this list. It’s quick comfort in an uncomfortable time. But it’s not sustainable.

My favorite coping mechanism, however, is work. And I’ve felt this lately. When the Stay Home orders were issued I dug in. I added more to my plate. I advertised an online workshop and figured out how to broadcast and sell it, while my patient care continued almost as busy as usual. I went to bed thinking about it and I woke up with Instagram posts rattling in my head. I told myself it was “good” because I need to keep my business running. But this is not sustainable. It took me 6 weeks of overdrive to realize that this is me grasping at whatever I can find to stay out of my body. I wanted to ignore the tightness that settles in my chest, and the flutter in my solar plexus.

Can you relate?

I mentioned to a friend on Friday that I was looking forward to finishing Saturday’s workshop so I could feel back in my body, and she beautifully replied:

“I would ask you, how could you get back into our body BEFORE the workshop? What kind of difference could that make for both you and the participants?”

I took a breath. Then I listed off 5 things right away that I could do. Then I did them.

I closed my computer.

I turned on some music and danced in the kitchen.

I re-potted all my houseplants.

I knelt barefoot in the grass and dug my hands in the dirt.

I took a bath.

I came home to my body.

So I ask you the same: How can you get back into your body? What kind of difference would that make for you? For your family, your colleagues or your children?

Take a breath. Make a list of 5 things. And keep that list somewhere visible so you can remember. Because when we are in our body we are home.

Image credit: @onbeinginyourbody

How to Find Normal

It’s been about one month since COVID-19 took over and knocked us all off track. Day by day we were listening to the updates, what’s changing, what bad news is there, what else will be closed.

By now we know we’re in for it. School’s out and businesses are closed. We are home.

How do we settle into the new normal?

Sit down with a piece of paper. Set a timer for 5 minutes, and write freely about what “normal” means to you.

Then take a look at that list and categorize it into

1. What can you still do?

2. What are you better off not doing?

3. How can you modify to add it back in?

For example, I have been sleeping later (which I’m giving myself grace for), but I still get up and write morning pages every day with a cup of green tea (category #1).

Under category #2, I used to drive everywhere, like running to the store for 1 thing. I also grocery shopped several times a week. All of those are things I apparently can live without, and maybe am better off for it.

Finally, for #3, I miss going to the gym and yoga studio. Thankfully, both of those businesses are streaming classes online; I just need to remind myself to get it on the calendar and show up.

Now on to you: what kind of normal can you take back? Start small. Set an intention and hold it gently. Give yourself grace. Things are not normal. But in our small worlds, maybe some things can be.

Root Chakra

The root (or first) chakra is an energy center housed at the tip of the tailbone and associated with the perineum. In other words, essentially at the level of the pelvic floor.

Characteristics of this chakra include security, groundedness, power, and sex—certainly all things that I associate with the pelvic floor (even my western-medicine colleagues would agree that makes sense). It’s also associated with our basic needs—food, sleep, shelter, safety.

When those basic needs are threatened—as in our current world situation—our body can react by trying to grasp for them, trying to control them. In other words: it holds on.

Think of a dog that’s scared: it tucks its tail between its legs.

When we are scared—when our basic needs or power or security are threatened—we inherently “tuck our tail” too. But for us, that means we put all that tension in our pelvic floor. It is a false sense of control somewhere in our being, which in reality does not help us at all.

It can turn into pelvic pain, painful sex, tailbone, hip or back pain. It can change our relationship dynamics. It can give us feelings of scarcity or greed, a fear that we won’t have enough. That our basic needs will run out. (Hello TP hoarders.)

Take a couple minutes wherever you are to just check in with your root. If you’re rolling your eyes at the “woo” nature of what I’m saying, just check in with whatever parts of your body are contacting your seat.

Notice your sitbones, your thighs, your pelvis.

Take a couple breaths, and notice what you’re holding there.

What is serving you?

What is not?

Breathe into your pelvis, letting go whatever isn’t serving you. Let go of the tension. Let go of any unwarranted fear. Let it go.

Check in throughout your days: are you tense again? Let it go. This practice of checking in with your body becomes a mindfulness practice that can lead to feeling grounded, especially in these uncertain times. Release what doesn’t serve you, what is taking up precious energy in your body. Let it go.

Product Review: The Diva Cup

I was always a pad-and-tampon kinda girl until a few years ago. In 2015 my husband and I decided to do part of the Camino de Santiago in Spain, which meant we were going to be walking for 5 days, carrying everything we brought with us on our backs.

Of course, you know the timing of the trip lined up with when I expected my period. Of course.

The last thing I wanted was to pack a box of tampons just-in-case and take up precious space and weight. Especially considering the fact that my bleed was still pretty unpredictable at that time, so it stood the chance that I wouldn’t need it at all.

These were the circumstances that led me to finally try a menstrual cup. Back then (ok it wasn’t that long ago) the Diva Cup was the only product on the market—but if you search “menstrual cup” today you’ll find all sorts of makes and models!

I bought it a few months early so that I wasn’t testing it out on the road, and gave it a couple cycle’s practice. Here’s my review, including things I learned and how it best serves me now:

Pros:

• Reusable/less waste

• You can wear it up to 12 hours on a light day

•  More comfortable than tampons, especially on a light day

Cons:

• Murder factor is high when removing it

• Makes my cramps worse

• Challenging to get in and out, especially if it pops open when you’re not ready for it...

• Leaks on heavy days

• The stem can be poky*

Overall, it has become something I would wear if I wanted to go for a swim or take a bath, or if it was a light day and I didn’t want to worry about changing pads. Though I always wear a pad for backup, because it usually leaks on me when it gets full.

Couple things to note:

• Flip it inside out if the tip bothers you (this was a game changer for me!)

• Make sure it seals around your cervix by squeezing the air out of it

• Bear down gently if you have a high cervix and have a hard time getting it out

• Check out the videos here for help with insertion!

In summary, this isn’t my fave right now, but it served me well for a few years. It might be good for you if you have light flow and a higher cervix, and aren’t afraid of getting all up in there!

Product Review: Intimina Ziggy Cup

I posted a story on instagram about this a couple months ago and some of you have been asking for the review, so here it is. I have found that it takes a few cycles to really get a feel for a new menstrual cup, so I wanted to give it at least 3 rounds before I shared my thoughts.

And it’s a good thing I did! Because I figured out something MAJOR about this one during my last cycle. I’ll get to that.

Here’s my thoughts on the Intimina Ziggy Cup.

Pros

• Easy to insert and remove

• Reusable/less waste for the environment

• Comfortable/minimal feel when it’s in the right spot

• You can empty it without taking it all the way out!

• Cute pink color and VERY soft material

• Discreet and breathable storage case

Cons

• Murder scene factor is high when it comes to emptying it (aka bloody hands)

• Easy (for me at least) to get it in the wrong spot*

*So, during the first cycle I didn’t have high hopes. The first day I wore it, it FAILED the workout test (meaning I had lots of leaking at the gym). I figured it just wasn’t a heavy-day cup for me. BUT. This last cycle it did the same thing, so I did some investigating. Turns out—I assume because of the flat shape of it, combined with my anatomy—I accidentally placed it IN FRONT OF my cervix, which of course is going to decrease the efficacy. Once I got it in right, and henceforth always checked to make sure it was in right, I’ve been good to go.

In summary, compared to the Diva Cup (my only other cup experience to date, and yes a post is coming about that too), it’s easier to put in, takes the same effort to make sure it’s in RIGHT, is much easier to remove, more comfortable, and leaks less.

PLUS the fact that you can empty it without taking it all the way out gets MAJOR points for this bleeder.

It boasts that it’s friendly during period sex, but I haven’t tried that yet...nor do I really plan to, to be honest. But you do you. ;)

This is my new go-to, but I’ll keep you posted if and when I try another. Keep an eye out for my Diva Cup review next week.

What’s your go-to menstrual product? Share in the comments!

On Menstruation

Let’s talk about menstruation.

What was your first bleed like? Was it a positive experience? Were you prepared for it? Were you scared, ashamed, mortified?

My first period came when I was 10. I was on a field trip to Makoshika State Park, and I was mortified. I didn’t tell anyone. Later that week my mom called me downstairs to the laundry room to point to a pair of undies and ask what was going on, and I was again mortified. My friend was over and I was just sure she was going to hear what we were talking about. I don’t remember what my mom said. I don’t remember if she gave me pads or where we went from there. I just remember I didn’t want to talk about it. I felt shame.

I don’t know if it’s because I was so afraid to talk about it then, but I really want to talk about menstruation now. I feel that our culture has placed so much shame on it, and we need to shed light on it to bring it out of the shadows. I’m grateful for many authors* and leaders talking about it more, and I hope this trend continues.

Our blood is not dirty. It is not filthy. It is not shameful. The Red Tent of Biblical lore was not in fact a place where the “unclean” were sent, as I learned it—it was a place where women bled together, shared stories, and taught one another what it was to be a Woman. (Pick up the novel The Red Tent for an incredible read!)

We are cyclical beings in a patriarchal society, which expects us to show up exactly the same every day of every month. But we do not work that way. We work in a 28(ish) day cycle, and we show up differently in each phase.

We are accused of “PMS-ing” or being bitchy when we have a hormonal shift that turns us inward when we feel less accommodating to others. This is fine. This is good. This is not something to be ashamed of or medicated away, but something to embrace and plan around.

When we are mid-cycle and fertile, we are magnetic and energetic! This is the full moon energy that many of us wish we could embrace and live most of the time. But we aren’t meant to live here most of the time, just as we don’t expect the moon to be full most of the month. We need our downtime, we need the dark moon.

The menstrual cycle is a full cycle. Though we commonly call our bleed the cycle, we are constantly in the cycle; bleeding is just 5-7 days of it. There is power in embracing our cycle and the magic of each phase.

Here is a list of some of the resources that have helped me navigate my relationship with menstruation. Let’s keep this conversation going and continue to shed light on it!

Women’s Bodies, Women’s Wisdom by Christiane Northrup

Love Your Lady Landscape by Lisa Lister

Do Less by Kate Northrup

(Image by DO MATO Design)

Pelvic Floor Function #4: Stability

You’ve done core exercises, right? You’ve probably had a coach or a yoga teacher say “engage your core” or “tighten your core” or “we’re going to work on your core.”

But what is the core?

Let’s break it down:

There are two groups of core muscles: the deep core and the outer core. Think of deep as the “stabilizers” and the outer as the “movers”. The deep core prepares for movement by “zipping up” the trunk, then the movers actually, well, move.

Let’s dive into the deep core. This layer is made of four muscles that create the “canister” of the trunk: the pelvic floor is below, the deepest layer of abdominals (transverse abdominis) in front, the deep back stabilizers (multifidi) along the spine, and the respiratory diaphragm at the top. Connecting all of these muscle groups is fascia, which is like the saran wrap of body tissue, making sure they are all interconnected.

When all four of these muscle groups are coordinated, they sort of tighten or zip up just before you move a limb, keeping the trunk stable.

When one group is weak, injured, or uncoordinated, we lose some of that stability.

Think of a can of La Croix: when its’ sealed, it’s solid. You can squeeze the sides as hard as you can, or step on the top, and it’s going to stay solid. But as soon as you pop the top, you can squeeze the sides to crush it, or stand on it and it’ll collapse. Even if you break the seal just a little—the stuff inside will still squeeze out.

Our trunk is pretty similar. If the pelvic floor isn’t “sealing” properly when you cough, sneeze, jump, or laugh, some of the “stuff” inside leaks out.

Same goes for the back muscles, or the abdominal muscles in the front (think diastasis, which I’ll cover another day!), or if you’re holding your breath all day. If one or all of these muscles gets knocked off track, we lose an element of stability.

So next time you’re in a class and the instructor says to “engage your core”, add your pelvic floor into the mix.

Head back to read my posts about the other three functions of the pelvic floor for a complete picture: Sexual Function, Sphincters, and Support. And if you want a full tour, catch my video Tour of the Pelvic Floor here.

Pelvic Floor Function #3: Support

My in-laws have the most amazing hammock. It hangs between three trees and is built for 4 people (though admittedly we’ve had 6 adults and 2 children on it...). It’s made of a strong woven material, yet has enough give to make it incredibly comfortable. It’s quite supportive.

The deepest layer of your pelvic floor is designed in a strikingly similar fashion to that hammock. It slings between the sitbones, then connects to the tailbone in the back and the pubic bone up front. In a balanced pelvic floor there’s enough give to allow for some bounce during walking/running/jumping/etc, but it’s stiff enough to support all the organs.

Your bladder, rectum, and uterus (if you’ve got one) are all supported from the bottom by this hammock. There’s also support from ligaments that connect the uterus to the sacrum and the pelvis, and the uterus in turn helps support the bladder and bowel. They all hold one another up, with the pelvic floor acting as the most southern level of support.

After pregnancy, all the ligaments get stretched, and won’t return to exactly the same length they were before (they’re not quite as stretchy as muscle!). This may leave some feeling a sense of heaviness in the pelvis, or like things are falling out. This is typically because of prolapse— most commonly the bowel or bladder pressing into the vaginal wall. But DON’T WORRY: your bowel and bladder CAN’T FALL OUT. And it’s much rarer for the uterus to descend. (Another post will cover prolapse more in depth!)

The good news: by strengthening this deep hammock layer, you can reduce those feelings of heaviness (without surgery!) and keep things more in their place inside the pelvis. It’s like tightening the hammock back up after it got stretched out.

You can also give the hammock a break from gravity by going a little upside down. Try one of these postures for five minutes, a couple times every day (especially after exercise), and you should feel a little less heaviness. (If you don’t have a yoga block or bolster, just use pillows!)

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What do the other layers do? Check out the rest of this series on the Functions of the Pelvic Floor: Sexual, Sphincter, and stay tuned for next week’s post on Stability.

Pelvic Floor Function #2: Sphincter

When I as a freshman in high school, someone had gotten their hands on a dictionary of “dirty words.” Yes, this was an actual hardbound dictionary since we didn’t have Urbandictionary.com back then. The only word I remember learning was “sphincter.” Who knew that in my professional life this would be a word I talk about all the time? And: it’s not a dirty word at all. It’s just anatomy.

Sphincters are important. You probably appreciate yours right now if you think about it: are you peeing as you read this? Are you passing stool or gas? (Disregard if you’re reading this on the toilet). If you aren’t passing any body waste, are you thinking about doing a kegel? Probably not. Pretty cool, huh? Thank your sphincters.

A sphincter is simply a round muscle. You have one around each eye, your mouth, all through your digestive system, and most importantly for this post, around your urethra and your anus.

Both the urethral and anal sphincters have 2 layers. An inner layer is made of smooth muscle—which is the kind of muscle your guts and your heart are made of. You don’t have to remember to beat your heart all day, right? (thank goodness!) And digestion goes on in the background. These are smooth muscles and are run by your autonomic nervous system. And that’s the reason we don’t typically have to think about not peeing our pants all day long. SO GREAT.

Now when you DO feel an urge come on, or you feel some gas coming while you’re in an elevator, or you’re about to sneeze—you can squeeze to hold it back. That’s the second (outer) sphincter working, and you get to control that one. When you do a pelvic floor contraction, you are squeezing the outer sphincters of both the urethra and the anus (unless you’ve been practicing and are really coordinated at squeezing one but not the other, which quite frankly I can’t think of a real good functional reason to practice).

I call this the “Sphincter function” to stick with the S-theme, but really the function of these are continence, or keeping control of your bowel and bladder. If there is weakness in these muscles, it could lead to urinary, gas, or bowel incontinence. If these muscles are too tight, it can lead to difficulty emptying the bladder or bowels. We need a balanced pelvic floor for all of it to work smoothly.

See, sphincter is not a dirty word at all. If I could go back and be my 15-year old self, I’d tell those other kids about how freaking cool sphincters are, and that they should all be grateful for them. I’m pretty sure that’d give me cool points, right? Right...

Do you think they’re cool? Have questions? Hit up the comments below!

Stay tuned for the rest of this series on the Functions of the Pelvic Floor: Sexual, Support, and Stability.

Pelvic Floor Function #1: Sexual

This layer puts the “fun” in functional.

The most superficial layer of pelvic floor muscles is constructed of relatively small muscles that create a triangle around the openings of the vagina and urethra. When they contract, they do a couple things.

blogpost19_2.jpg

First, they help with arousal. They are connected to a little piece of skin over the head of the clitoris called the clitoral hood. When they tighten, they pull this little hood over the sensitive head of the clitoris, contributing to arousal.

Fun fact: did you know that the clitoris is the only organ in the human body that is solely there for pleasure?! It has no other function. Just pleasure. It is analogous to the glans penis, or the head of the penis, but even that is dual functioned since the urethra passes through it. How’s that for some great anatomy?! 

Another important fact: most women only have orgasms through clitoral stimulation. There seems to be long standing rumors that you are somehow lacking if you can’t have an orgasm through penetration alone—but if that’s you, you’re NORMAL! The G-spot is kind of an elusive thing that may or may not be real, but most arousal and orgasm do originate at the clitoris.

The second way this layer contributes to pleasure is to bring in blood flow to the genitals. A smooth rhythm of contraction and relaxation brings blood flow in and leads to engorgement. If you ever want a deep dive in to all that goes on in your body during arousal, check out Woman’s Anatomy of Arousalby Sheri Winston. She actually takes you on a tour of your anatomy that includes watching the skin color change at different stages of arousal due to increased blood flow to the labia.

Finally, the one that gets all the attention, is the Big O. During climax, the pelvic floor and uterus contract together to contribute to orgasm. Of course, it’s not just a muscular phenomenon, but they do play a major part. There is a little research that supports pelvic floor strengthening to increase orgasm, and a lot of “tools” to help you do that (for better or worse). It’s important to understand that an orgasm has a large psychological and emotional component as well, though. So kegels are not necessarily The Answer if you’re struggling in this area.

For the muscles to be able to contribute to optimal pleasure during sex, they need to be able to tighten—but they also need to be able to relax. If they are too tight during initial entry, there can be pain. If there are knots in the muscles, they can also cause pain during penetration, orgasm, or after sex, as well as pain with inserting fingers, tampons, and anything else.

There you have it: though they are small muscles, they have a mighty function. Stay tuned for the rest of this series on the Functions of the Pelvic Floor: Sphincters, Support, and Stability.

Questions or comments? Leave them below!

Back to Basics: Layers of the Pelvic Floor

The pelvic floor has 3 layers of muscle, and 4 basic functions. Today I’ll cover the anatomy and layers, but each function deserves their own post, so keep checking back for more detail over the next few weeks.

*If you learn better by watching and hearing, click here to get access to a video I made covering everything in this post!

The most superficial layer consists of relatively tiny muscles that are much appreciated. Their primary job relates to sexual function. They create a triangle whose angles land on the pubic bone in front and each sitbone. One muscle reaches on each side from the pubic bone to each of the sitbones. Another reaches sitbone to sitbone across the perineal body (a very important junction of muscle and tendon between the vagina and anus, which can be torn during birth). The third group of this layer wraps from the pubic bone, around the vagina and urethra, meeting at the junction of the perineal body.

The deepest layer acts like a bowl and covers the majority of the space between the pelvic bones. This layer is largely for pelvic organ support, and because of the relative size of the muscles, is most likely what you feel tightening if you do a kegel.

In between those is a middle layer that includes sphincters (aka round muscles) around the urethra and the anus. These are SUPER important (and do so much without us thinking about it!) as they keep us from leaking urine or stool all day long.

When you contract the pelvic floor, you’re likely squeezing all three of the layers, superficial to deep and front to back. Some people can differentiate front to back, but it takes a lot of body awareness.

Most of the muscles are just like any other muscle in your body: they can be strong and toned, weak, atrophied, tight, or have trigger points (or “knots”) in them. Crazy, huh? That also means they’re trainable, so if they’re weak, they can learn to be strong. If they’re too tight or painful, they can learn to relax. Sometimes they need massage or release. They’re like your shoulder muscles: if you hold tension there, you can remind yourself to drop your shoulders and relax. But often times it takes a good relaxing massage to really get them to release. The pelvic floor can be the same. (Please oh please make sure you find a trained and licensed professional to do this work!)

The next few posts will break down the functions of the muscles: Sexual, Support, Sphincters, and one I didn’t mention yet: Stability. Stay tuned or sign up for my email list to get it sent right to your inbox!

Back to Basics: Take a Look

Getting to know your body starts with knowledge of what you’ve got. While high school biology covers the basics it typically misses some pretty important parts. I can’t tell you how many people in the clinic tell me I am the first person to show them a picture of their pelvic anatomy—or show them their own with a hand mirror. While I hate that it’s the truth, I do LOVE being that person. It gives a person back a piece of their own power.

If you’re so inclined, grab a mirror, get comfy on your bed with good lighting, and follow along this little map to see these yourself. I truly believe the more we know about our bodies, the more ownership we are able to take. I know it weirds some people out, and that’s fine. But I truly believe there is nothing shameful about the human body, and these are important basics to know and experience.

Here’s where we start:

Women have 3 openings in their pelvic anatomy. From front to back, there is a urethra, vagina, and anus. This may be old news to you, but I can tell you—there are adults who don’t know this.

More on these openings:

Urethra:

This is where urine (pee) exits. You may or may not be able to see this on yourself, because our anatomy varies. Sometimes it’s easily seen just right there beneath the clitoris (that part deserves its own post!), but sometimes it’s tucked up more inside the vaginal opening. Separate the labia minora (literally “little lips”) and see if you can find yours.

Vagina:

This is where menstrual blood and discharge exit, where your tampon or menstrual cup goes, and where sex often “happens.” I once had a young new mom look at my pelvic model and ask “Where does the penis go?” THIS is where it goes (usually). And with a vaginal birth, it’s where the baby comes out. (It’s so good to know what it looks like before you have a baby, so you know what your baseline is! It will always look different after birth though)

Anus:

This is where bowel movements (poop) exit. While your mouth is the start of the digestive system, this is the end. Hemorrhoids can show up here too.

That’s about as basic as it gets. Start here to orient yourself. While you’ve got the mirror out, do a pelvic floor squeeze, and see what changes (you should see everything pull inward). Release then try pushing out a little (you should see everything push out a little). You might not see anything change at all, or you might see a LOT of movement.

Want a more thorough tour? Click here to get access to my free video Tour of the Pelvic Floor.

If you really want a more thorough assessment, get yourself to a Physical Therapist who specializes in pelvic health. If things don’t seem right down there, or if you just want to know more about what you’ve got, they can be a tremendous help. It’s YOUR body, after all. You deserve to know everything you can.

Image: @priii_barbosa

Reflection + Intention: The NEW “New Years Resolutions”

I’m not a big fan of New Year’s Resolutions. What are they—they’re ideas we get all excited about in January, then we do them hardcore for a month, then fall off the wagon, then feel guilty about it (if we even remember that we set them...). Amiright?

What if we did it differently. What if we replaced “New Year’s Resolutions” with Reflection & Intentions. The following is an exercise that in part I adapted from Kate Northrup. Carve out some time to try it out.

REFLECTION

Set aside an hour or so this week. Find a quiet space—maybe a coffee shop or maybe your kitchen table. Grab your calendar (or calendars if you’re me...) and a cup of tea or coffee.

Begin by closing your eyes, and focus on your breath. Get present with yourself and check in with your body. This is an exercise of noticing.

When you feel present and ready, start to look back through your 2019 calendar one week or month at a time. Look at the activities or events you have written down. Stop after each one and notice in your body:

What makes me expand?

What makes me contract?

For example, I looked back and saw a weekend in June that was filled with a friend’s Bachelorette party that included a bike winery tour in Hood River. You bet that made me expand—I smiled just looking at the words on the page. The next week I had four days of working at a job I didn’t enjoy—I contract just thinking about that.

INTENTION

After your reflection time, take out a blank sheet of paper. Or you might choose what my husband and I do, and tape a huge piece of butcher paper to the kitchen wall. There’s a G column, a Mandi column, and a shared one in the center.

Make a list of Intentions for the year. Some of them might look like goals. Some might look like tasks. Some are dreams. None are resolutions, and none have to be set in stone.

In 2019 our list included things like “get a dog, start a business, pistol squat, build garden beds, plan for retirement, go to Paris,” etc. A lot of them got crossed off. Our 10-year anniversary was on the list—that was going to happen no matter what, so it was a sure bet to get crossed off! Having it visible throughout the year gave us a sense of accountability to remember our dreams, a quick glance reminded us of some boring to-do’s, and the Sharpie looped into it made it gratifying to cross things off.

Try it out. If you do, please share in the comments below what some of your Intentions are! I’d love to hear. ✨

How to Stay Present During the Holidays (or any time)

As I grow older, I realize more how much goes into the holidays that I didn’t realize as a kid. We spend so much money. We stress over what to give who and which family to go visit. We make plans. We reschedule said plans. We realize that our partner made plans at the same time as our plans so we do two things in one night and realize we weren’t fully present at either one.

Why do we do this? What happened to all the magic that the holidays held when we were kids?

I think we just grew up.

Is there still magic in this season? Yes, I believe there is. Because I believe there is magic in every season, and in every day. We just have to sit still and be quiet enough to notice it.

I’m writing this down for both of us. Because I by no means have it all figured out. I just happen to be writing this from a tiny desk in a small room on a one-day silent retreat. This is all fresh on my mind because there’s no noise to drown it out.

How to stay present during the holidays (or any time)

-       Find stillness.

- Wake up early and read in bed.

-       Light a candle and invite your family into a moment of silence.

-       Stay up late sitting by the Christmas tree.

-       Take a walk. Notice the sky, the grass, the leaves, the lights.

-       Find a token. Look for a small rock and keep it in your pocket. Hold it or rub it throughout the day to remind you of the earth we inhabit.

-       Meditate. Sit comfortably. Or lie down. Notice your breath. Silently say “I’m breathing in” then, “I’m breathing out.” If your mind wanders, notice that, and come back to your breath. Do this for 5 breaths. Or 5 minutes. Or longer.

-       Do a sun salutation. No one says you have to go to a studio and pay for a 60-minute class to “do” yoga. Make it up in your living room, on your rug, or at the airport. Just move.

-       Write. Take out a notebook or journal and write 1 page, or 3 pages, of anything.

-       Take a moment to notice your body. Close your eyes. Feel where your body is contacting the ground, the chair, the air. Notice the angles of your joints. Notice areas of tightness, discomfort, ease. No need to change anything: just notice. 

There are a few things we have with us all the time: our body, our breath, our mind. We can use these things to touch down, to remember where we are, who we are, what we are. It’s so easy, yet sometimes so complex.

But it’s nothing short of magic. ✨

Your turn: how do YOU stay present during the holidays? Share in the comments—I’d love to hear more ideas, and we could always use more tools for this magic!

6 Tips for Smooth Moves

Whether it’s because of travel or a wacky holiday diet consisting of gingerbread houses, it’s not uncommon to feel your digestion sloooooow down during the holiday season. Here are some tips to keep things moving smoothly:

1. Stay hydrated

It’s recommended to drink about half your body weight in fluid ounces each day, and most of that should be water. For example, if you weigh 160 pounds you should be drinking about 80 ounces a day. Your body takes in all the fluids that you drink and disperses it for its own uses throughout your systems. If you’re dehydrated, by the time your food is all digested and ready to leave the system, there’s not enough water to go around, and your stool becomes hard and dry. That makes it hard to pass, sometimes causing constipation, painful bowel movements, the need to bear down, and hemorrhoids. Basically, a BM can be a big bummer.

2. Add in some fiber

It can be hard to keep track of how much fiber you’re taking in on a good day. Around the holidays, when your lunch might consist of the deli platter someone brought to work or the Christmas cookies your kids decorated, it can be even harder (which can mean your stool is harder too...)

The easiest way to get your fiber is to add in a supplement each day. My favorite recommendation is psyllium husk, but you might find another type works better for you. (*Ask your pharmacist or care provider for recommendations if you’re pregnant, want more direction, or if you are unsure of any interactions with medications you may be taking.)

Start by adding in the smallest dose recommended on the package, and continue that for one week. After a week, increase or decrease according to how your body is responding. Your bowels like habits, so if you’re hit or miss on a supplement, you won’t get the full benefit.

Taking it in the evening can prevent discomfort of cramping or a belly ache, and make sure you drink plenty of water along with it (back to recommendation 1!)

 3. Listen to your bowels

If they say they gotta go, they gotta go! They aren’t like your bladder where you can ignore the urge. Even if you’re at work or at a party, follow their lead. I always remind myself that everybody else poops, which makes me feel better about having a BM in a public restroom ;)

4. Try abdominal bowel massage

If you feel like you need to go, and it’s just not moving through, try this simple abdominal bowel massage. Start at your right hip bone, and massage in small circular pattern toward your ribs. Then continue across from your right lower ribs to your left, then turn the corner and massage toward your left hip bone. Continue this clockwise pattern until you feel some gas or stool starting to move. It’s just like magic. (for a video, check out my Instagram Highlights)

5. Get moving

Go for a walk. Head to the gym. Physical activity helps to stimulate our bowels. Take the whole family for a post-prandial stroll. I have fond memories of taking a walk around Kiwanis park in Great Falls, Montana with 4 generations of my dad’s family after Thanksgiving dinner. (Though I wasn’t thinking about my bowels back then!)

6. Put your feet up

I’m always a fan of the Squatty Potty, because it just makes pooping easier. Having your knees above your feet tilts your pelvis in a way that helps relax the pelvic floor and “un-kink” your rectum. Don’t have a Squatty Potty? Throw your kid’s step stool under your feet, or flip a garbage can on its side. In a pinch, if there’s extra TP rolls, just put one under each foot. It will make everything easier (and faster!)

There you have it. My six best tips for keeping your bowels moving smoothly throughout the holiday (or any!) season, no matter how much eggnog you take in. ;)

(If you try all this and find you’re still having bowel troubles, it might be helpful to see a PT. Schedule a free 15-minute phone consult here so we get you on the right track!)

6 Reasons to See a Physical Therapist BEFORE the Baby Arrives

If you’re like me, you grew up thinking that having a baby looked kind of like this: 

Your water breaks in a really dramatic gush. You rush to the hospital (that baby is coming any second!) then suddenly are lying on your back with your legs in the air while a doctor in a white coat catches the baby.

Add in some dramatic screaming and pushing and you’ve got the picture.

Can anyone else relate? While yes, there are births that I’m sure look like that—it’s TV.

Many people have days of labor, change positions too many times to count, and give birth not only in a hospital but perhaps a birthing center or a pool or the bathtub or their living room. The possibilities are almost endless, but—especially with the first baby—it’s usually not a quick process.

Labor & delivery is often a long, exhausting event. It’s something you need to prepare for—get in shape for, if you will. For example, if you’re pregnant and want to labor in a squat (a great option for opening the pelvis), you need to make sure you can squat before those contractions even begin. A deep squat takes strength, endurance, and a lot of hip, knee, and ankle mobility.

This is where physical therapy comes in to play with L&D. Most people don’t think of PT before labor, unless they’re having pain of one variety or another and were referred by their midwife or OB. Seeing a PT during pregnancy can prevent pain & discomfort, and prepare you for the big event.

6 Reasons to See a Physical Therapist BEFORE the Baby Arrives:

1.     They can teach you perineal massage. While we can’t say if this truly prevents tearing during delivery, we do know it helps you learn how to keep your pelvic floor muscles relaxed during the discomfort of a lot of perineal stretching. A relaxed pelvic floor = an open path to the exit!

2.     You can learn how to actually push during labor. Ask your friends: how many of them said they didn’t know how to push when the nurse or midwife started telling them to do it? A PT can help you learn what it feels like to lengthen the pelvic floor while pushing with your abdominal muscles so it’s familiar when the time comes.

3.     Practice labor & delivery positions. A PT can make sure you have the joint mobility to get into a deep squat, a lunge, hands and knees, and any other variety of positions that can help open the pelvis and move the baby down. We can educate you on the benefit of different positions and help you figure out which ones you need to practice before the big day.

4.     Make sure your partner knows how to physically support you during labor. Bring your partner to an appointment or two so they can learn ways to support you in a variety of labor positions, perineal massage (you might not be able to reach eventually!), and comfort measures.

5.     Balance the pelvis & uterine ligaments. If your pelvis is a little shifty or your ligaments have restrictions, it may affect baby’s ability to move down. As long as you’re later in the pregnancy, a PT can use manual techniques to make sure everything is balanced and ready to go.

6.     Get educated on postpartum care. When can you start doing kegels? When can you start doing abdominal exercises? What do you do if you had a cesarean? How do you get out of bed comfortably? We can give you guidance on all of this and more (with handouts, of course) so if you have questions after baby comes, you have the resources right there.

If you are expecting (congratulations!), I can’t recommend seeing a PT enough. If you’re in the Tacoma area, schedule a FREE 15-minute phone consult with me to get started. If you’re farther away, check out these resources here and here to find a PT near you. The best thing you can do during pregnancy is to educate yourself and be prepared for anything. Making a PT part of your team will be a huge benefit to that end.

Did you have PT during your pregnancy? How was your experience? What else would have been beneficial to know going into labor? Share in the comments!