My journey to recovery
Back Pain and Weight Loss
In 2009, after 4 years of part time study, I graduated with a Master’s degree with back pain, weight gain and a bladder that was leaking. I was 48.
My back pain reached the point that when I got up in the morning I was bent over from stiffness in my hips and back. I remember thinking ‘I feel like an old woman.’
I would occasionally leak urine when sneezing and I had to find a bathroom or jump into the bush when out on hikes or biking. Bladder urge was getting worse and ‘just in case pees’ became normal and just something I did whenever there was a bathroom handy. Even my husband automatically asked me if I needed to pee anytime we left a restaurant or were heading out the door.
My initial approach to “fix” these issues was to focus on weight loss, a strategy that had always worked for me in the past.
Embracing cardio, I started cycling and bought a road bike. And so began the expensive solution of finding a bike that did not leave my back aching. One bike was too big, one was too small, however I never found one that allowed me to bike without back pain. And of course, I thought if I kept cycling my back would get stronger. The reality is that my back got sorer and my hips started waking me up at night.
More Stretching and More Cardio
I thought that the soreness and hip pain was because I wasn’t stretching enough. So I started stretching more. And, because I wasn’t seeing the gains I was used to seeing with cardio, I also increased my bike rides to 50-80 km. I had been raised in the Jane Fonda era of cardio and more cardio, and so my attitude was that if it wasn’t “working”, I just must not be doing enough.
Predictably, my back didn’t get any better. My hip pain got worse. I tried adding swimming lengths to strengthen other muscles, thinking that maybe a different kind of cardio would help. And so began the era of double up days. A swim and then a bike ride. Some days it was a walk and a swim. I was desperately trying to regain the strength I had lost during the 4 years of sitting to complete my Master’s degree, and I didn’t want to listen to anyone’s suggestions that I might be overdoing it or hurting myself.
Two years later I was 50 and my back and right hip and leg were sore all the time. However, when the opportunity arose to go on a bike trip with friends to the Alps, I didn’t hesitate. I was used to cycling 80km days, I figured that it would be fine.
It wasn’t. My back, already stressed and sore, quit on me. I couldn’t sleep because of back pain for the next two years. Even swimming aggravated my back pain.
I felt so confused, angry, and impatient. I have always been an active person. Why was my body doing this to me? I didn’t know what to do, or how to be. I struggled with everything, including how to eat. If I wasn’t biking, hiking and swimming, I was worried that eating so that I had energy would mean that I would also be gaining weight and not fitting into my clothes.
By 2016 I was discouraged. I was still biking but only short distances. I could hike and cross-country ski with lots of stretching, but I was still sore most of the time. I tried HIIT classes. My back did not improve.
Pelvic Floor Physiotherapy
By 2017, I was 56 and still struggling with my back. I had seen a physiotherapist, an osteopath, an acupuncturist, and a massage therapist all with no lasting improvement. So, I started to lift weights including using kettle bells. And I ignored all the rules of starting slow. I started by lifting heavy weight without learning how to lift and breathe to include the inner core.
As I increased the weights I used in Kettle Bell classes I started feeling like I had a urinary tract infection (UTI). After being treated for a UTI with no change in symptoms, I realized I had a pelvic organ prolapse. That’s when I went to see a pelvic floor physiotherapist, and finally got some answers that worked.
Pelvic Floor Dysfunction including the Genital Urinary Syndrome of Menopause
With the help of a pelvic floor physiotherapist, I realized that I had been ignoring all the other symptoms I was experiencing. Decreased sensation with sexual arousal, increased bladder urges and frequency, discomfort on my bike saddle and with sexual intercourse. Increased stress incontinence. And constipation.
I was in perimenopause. That meant that there were changes in my body that required me to change how I was approaching movement and exercise. AND- it didn’t have to be this hard. What I thought was normal aging were in fact symptoms of pelvic floor dysfunction as well as the Genital Urinary Syndrome of Menopause (GSM). This means I had a very weak inner core muscle system that was also affected by decreasing estrogen (more on this below). My back was sore because my core was weak.
What I Learned in Pelvic Floor physiotherapy that helped my back
Back pain in women is different during the perimenopause-to-menopause time of life. More cardio and stretching are not the answer. Everything I was doing to try and make myself stronger was actually contributing to the pain and weakness I was feeling. Luckily, having someone help me learn how my body works and ways to work WITH my body in this time of life helped with my low back pain. This helped with leaking, with sexual pleasure, and with finding a daily movement practice that worked for me.
What changes did I incorporate into my life with the help of a pelvic floor physiotherapist?
- I finally recognized that it takes 3 months minimum to start building muscle strength and control so I needed to check my ego and build my core from scratch however long it took. This meant going SLOW and GENTLE with myself.
- I started doing specific breathing exercises that helped engage and RELAX my pelvic floor, while engaging and STRENGTHENING my inner core muscles. I do these daily.
- My vulva and vagina and bladder needed estrogen so I started by talking to my doctor about discomfort during and after sexual activity. While I tried vaginal estrogen, it was not enough for me. I started DHEA this year and have found it helpful.
- I built a robust inner core by building a consistent weekly weightlifting program that is scheduled in my calendar.
- I focused on eating for nutrition and energy, and not for weight loss. I prioritize protein, fats and fibre at each meal, and I don’t restrict foods that also bring me comfort. I also cut out caffeine and drink more water to help with my bladder urges.
- One of the most important parts of this recovery included prioritizing sleep and rest. I focused on going to bed most nights by 10:00 pm, and also having days that included resting- something I’m not always good at validating in myself.
Building a stronger inner core and an engaged pelvic floor took time, energy, and focus. In other words, it became a priority just like brushing my teeth and progress was not linear.
RESULTS to DATE
It is now 2023, my inner core is so much stronger. I weight train 2-3 days per week for 30 minutes to a 1 hour. I can bike without having back or pelvic floor pain and I can hike with good bladder control. And when I do get a bladder urge, I can often control my bladder so have relatively few leaks.
I no longer wake up with back or hip pain. I occasionally can sleep through the night without having to get up once to pee which is considered normal. And intimacy is much more fun.
Something I have learned about myself is that I tend to push myself too hard in order to “see results”. It has been eye-opening for me to realize that I get the best “results” (little to no pain, few leaks, enjoyable sex life, clothes fitting my body) when I am kind to myself and prioritize resting and gentle movement. I notice on days that I push too hard- treating myself like I am 20 years old- that some of the dysfunction comes back (waking up at night, leaking, pain etc).
Why I became a Pelvic Floor/Health Physiotherapist
When I reflected on everything I had physically experienced since the birth of my first child, I realized that as a physiotherapist with 2 degrees I did not have the training to understand my own body or manage my own body. None of the health professionals that I saw seemed to understand the unique needs of a woman’s body who desired to remain physically active.
After feeling sad and angry about the lack of training I had received as well as the obstetrical care that had damaged my pelvic floor, I decided that I would learn as much as I could about how to assess and treat women who experienced obstetrical injury or change to their pelvic floor and inner core during pregnancy. These women desired to remain active and were looking for the same answers that I had sought.
My own experience reinforced what I was reading: that women in the peri to post menopause years who experienced leaking, joint and muscle pain with movement, weight gain, and or difficulty with sexual activity are underserved in the medical as well as the rehabilitation world. I decided that I also wanted to know how best to assess and offer care to these women who are in midlife with very full lives. After completing the foundational course to certify as a pelvic floor physiotherapist, I invested in a 4-month course that covered all things menopause including hormonal health, plus a foundational program in strength training in this age group.
And still there is more to learn. I recently completed a 3-month Pelvic Health Sexuality Counselling and Education course so that I can ask better questions of my patients regarding sexual health as well as have more information and education to share with my patients.
My biggest teachers are the women I see who are tenaciously reclaiming their health, mobility, strength and sexual pleasure. I am honoured that they have entrusted me with their care. Their questions and concerns push me to read more books, listen to more podcasts and continue to scan the research. I love my job and I feel so blessed to have found pelvic floor physiotherapy. My days are spent keeping my own body strong and mobile and working with women who are aiming to live, move and love on their own terms with strong and resilient bodies. My motto has become “your body, your story, your journey”—true for me and true for my clients.