“Huh! That’s a new one!” Dr. Rachel slips the pillowcase from my forearms and invites me to stand up straight and try the exercise again at a new angle. “Let’s try it again with your arms parallel against the wall, but no resistance against the pillow case”. I try again, still unable to complete the exercise without engaging my neck and arching my back. “We’ll revisit this next time. I’ll do some more research.”

Every Pelvic Floor Physical Therapy appointment is like an episode of House, Dr. Rachel and I gathering data, experimenting, and searching for puzzle pieces to snap into place and point us in the right direction.

“Tell me about your pregnancy and delivery” she prompts on our first meeting. I regale her with stories of my pubic bone splitting apart in my third trimester, of the 31 hours of labor, the pitocin, the forceps, the suction. I tell her about the precious babe struggling for her life inside me, about the tearing and the terror.

“Your body remembers all that. It doesn’t magically forget when the baby comes out.”

I read that book, I tell her.

“I had problems before I got pregnant.” So we talk about how I was born with both hips dislocated and had to wear a brace as a baby. “My parents are both dead” I reveal, “so I can’t ask them any details.”

We talk about injuries and running and tight hamstrings. About breathing problems, colonoscopies, and recurrent hives. About all the doctors, acupuncture, chiropractic, meds, therapies and massages I have tried. We talk and talk. More information. More clues. More puzzle pieces.

We talk with her hands on my lower ribs, her palms gently pressing my bones back into place where pregnancy splayed them outward and they forgot to contract for 9 years. We talk with her gloved fingers inside my body, pressing against the inside of my pelvic floor as I raise and lower my legs with angst and strain. We talk as she hands me a pillowcase to use as a prop in an exercise that is supposed to activate the muscles along my side back, but instead fires up pain in my neck and upper back.

I came to Dr. Rachel after a flu strain ravaged me for 8 long days, and I punched and kicked at a painful cough that lasted even longer. As I stood feverish and sweaty with illness in my living room watching my joggers soak with my own pee, I vowed to finally do something about the Cough/Sneeze/Laugh/Run-and-you’ll-leak situation. It was more like floodgates than leakage, so I knew it was time to get some help.

“If anything, my pelvic floor is probably too tight.” I mentioned to Dr. Rachel as she preps with gloves and lube to press around inside me to get the lay of my pelvic floor land. “It feels like I can’t contract any further to stop the leakage.”

Turns out, the muscles you think of when you think of pelvic floor are pretty solid – not too weak, not too tight. And so began our exploratory, therapeutic sessions to try to learn what my body is holding, and where, that makes it so hard for it to hold my pee when I cough or sneeze. My body’s hands are full, as it were.

Y’all, I was not even prepared for this fascinating, frustrating, beautiful adventure.

For one thing – my rib cage. It expanded outward to make room for baby, but never went back into position. Without my rib cage to fence it into place, my diaphragm has slid into my mid-abdomen and bangs dramatically downward towards my bladder when I cough. Guess what? I’M GONNA GENTLY COAX MY RIBS BACK WHERE THEY BELONG, with Dr. Rachel’s help and daily exercises. Can you believe that? I’m going to smoosh my ribcage back to pre-baby positioning. Dr. Rachel will keep massaging my abdomen at our appointments to convince my diaphragm to nestle back up in my ribs where she belongs. Magic.

Next, who knew my lower extremities had anything to do with incontinence, but it turns out that my extraordinarily high arches and these ankles that are so rigid that Dr. Rachel concluded that it’s likely that’s just how my body is built, mean that I don’t have any shock absorption for those barking coughs. Force from the ground is radiating upward to put pressure on my bladder in addition to the unnatural force on my misplaced diaphragm. My body is clapping with my bladder from my feet to my rib cage every time I cough.

But wait! There’s more! Lots more. I won’t bore you with the minutia, but what we’ve gathered so far is that my body is so far out of whack that my dear, hardworking muscles and bones and tendons have been dutifully picking up slack for one another, compensating for strains and misalignments that would otherwise be debilitating. But that leaves some muscle groups getting beefy while others grow soft, and exacerbates and reinforces the pains and sudden functional dropping of the ball (I’m looking at you, bladder).

Why does my neck get involved in a back situation? Which muscles need to be loosened and given some time off to allow my pelvis to realign? Which muscles need to hit the gym? What’s the best way to address the overcompensations? Each therapy session asks as many questions as it attempts to answer. We’re moving forward, though. Miraculously.

Did my pelvis every really recover from that total cartilage split 9 years ago? Will sorting all this out help my breathing, my snoring, my digestion even? How did I run a marathon on ankles that barely bend? Did I mention I have two extra bones in each foot that are probably getting in the way, but here I am, walking around?

I’m so damn proud of this nearly 46 year old body. How hard she has worked, everything she’s been through, everything she is still prepared to do for me. That she huddled the team together and reassigned the tasks to bring my baby into the world, to heal, to keep me upright, and to keep most of my pee in my bladder until I’m ready to release it. Well done, you. Thank you. We’ll figure this out.

**It is an absolute privilege that must be acknowledged to have an hour each week with someone totally focused on your body’s healing and functioning. The flexibility of my work schedule, the resources of time and money. It is an absolute privilege to be able to afford this specialty work – and that enrages me. We can swing it, which is a miracle. So many cannot and it makes me angry. I’m angry, and I’m amazed.