Amanda Fisher Coaching

I help women get crazy strong - physically AND mentally - through strength training, sustainable eating habits, and a heathy mindset.

Category: Support (page 1 of 76)

Postpartum: My Experience With A Pelvic Floor Physical Therapist

Last week, I made a case for getting your postpartum body to a women’s health physical therapist.  

This week, I’m doubling down on that same subject to tell you about my own personal experience working with a women’s health PT.

While I was researching a good one in my area, I learned pretty quickly that these professionals aren’t just laying around for a quick visit.  They are pretty specialized, for a variety of reasons, and when you try to get into visit them, they seem to be generally booked out fairly far (considering they are pretty specialized, this makes sense).  So I booked my first appointment with my PT when I was two weeks postpartum, and had it set for when I was almost five weeks postpartum.  I visited the Institute for Athletic Medicine.

To be completely transparent, I knew I needed to make this appointment based on all the new writings and research in strength and conditioning world.  I knew I wanted to get back into strength training COMPLETELY ready to begin training smartly and progressing smartly.  I knew, after last time when I didn’t really know better, that I needed to take this seriously.

And to be completely honest, I booked my visit with the attitude that I was doing my due diligence in my postpartum health, but that I was only going to have to “clock it in” because I was probably one of those women who didn’t have any issues.

Did you know that women’s health PT’s want to know EVERYTHING about your core and pelvic floor health?  How many times a day do you go #1 and #2, can you hold it, for how long, do you ever leak, does it ever hurt, do you have back pain, how were your babies born, how many babies, how long were labors, any assistance during birth, EVERYTHING.

Upon talking about all these things with my PT, we began biofeedback testing.  Which basically means, I got undressed from the waist down, and got hooked up to little electrode thingies on my butt, on my thigh, and on my hip, and then she began coaching me on contracting my pelvic floor.  Then my core.  Then my core AND pelvic floor.  And we found out pretty quickly that my pelvic floor was hypertonic.  Meaning, it was ALWAYS working – contracted – and trying to do the job my transverse abdominis wasn’t.  A strong muscle is one that can contract AND relax.  My pelvic floor could not relax….thus, it was very weak.  Apparently this is very common, and especially common in those who lift.  Who knew?  Ha!

So, my first appointment was basically getting me to recognize coordinating JUST my pelvic floor and JUST my core, and then the two together via seeing a computer screen and the use of biofeedback to show me when I was contracting, relaxing, and the like.  And, my PT sent me home with some exercises to do daily to work on this.  We found that I could get my best contraction and coordination in a seated position versus a side lying position.  My PT also coached me on the importance of posture – sitting up straight, stacking ribs over hips, etc – in all of my daily life to support healthy core and pelvic floor function.  Feeding and nursing positions with baby especially, since that’s where a bulk of my time was spent.  She also gave me a hefty reminder to sit the hell down a TON during the day, because my pelvic floor needed rest and recovery, and getting up and doing a lot just made it work all that much harder.  She also recommended a follow up visit in two weeks to assess strength and coordination.

It was quite the coincidence that a few days after my first visit, I was at home, and began thinking I had symptoms of prolapse.  I felt weird.  I felt like I had something possibly lower than it should be.  I could feel something lower than it should be.  Cue all the freaking out on the planet.  I’m going to spare you about two weeks of drama until I saw my PT again, but the Cliff’s Notes are that I sat my ass off, I saw my midwife for my final PP check, and I also sought out an OB to double check, and to establish care since my care with the birth center was complete.  I also had emotional meltdown after emotional meltdown.  I knew that a prolapse would change a lot of things for me, strength training wise and work wise, and to be honest, it sorta felt like I was majorly getting betrayed by my body.  After visiting the OB, I had a sort of sigh of relief.  She was pretty confident after an exam that I didn’t have a prolapse of uterus or bladder, but since I had some symptoms (like I couldn’t go #1 all the way gone), that it could possibly be very mild prolapse, OR it could be par for the course of being only six weeks PP and still nursing, with very loose joints and connective tissue.  She advised continuing on with PT, and checking back in sooner (versus a year later for an annual visit) if I felt like things were getting worse instead of better.  I was happy to have this feedback, but to be honest, I trusted the expertise of my PT over the OB.  Not because the OB doesn’t know anything.  The OB knows women’s health, and specializes in the overall health of me and my female anatomy.  However, she doesn’t have the expertise of how specific muscles and systems work, and how those muscles and systems need to be treated, how they need to function, and how they respond to force during daily activities (I’m not saying any of this “right” but I hope you get my gist).  Her job ISN’T to know those things, and so the help of someone who’s job it IS (the PT) is vital.

Upon visiting my PT for my third visit, she agreed with the OB.  Not a prolapse, but potentially a very mild one IF symptoms continued.  She also very optimistic that with additional exercises, we could take care of any issues. That visit was internal.  She checked the strength of my pelvic floor muscles, and rated them at a 2 out of 5 for strength.  We also checked coordination of them – could I contract them and not my TA, could I contract my TA and not my PF, and could I contract both together.  I was definitely getting way better at this.  Because I had good coordination, and because I was actually doing my exercises, she said I could begin strength training smartly, and without any additional load (aside from floor presses) than my bodyweight.  You KNOW I was jacked up to begin this!  I think that was somewhere around 7-8 weeks PP.  She also explained that while I thought I was feeling symptoms of prolapse, that it was likely my pelvic floor was just on overdrive, and that I needed to be diligent about relaxing it as much as I could.  I did that in various ways – laying on my back with my legs supported on a couch above me, and letting my legs have zero tension, doing some child’s pose stuff and breathing drills, and some other things I’m forgetting at this point.

Over the course of 14 weeks, I had five PT visits.  Each one, I could tell I was getting stronger and stronger.  I was also learning that those weird prolapse symptom feelings had way more to do with having an overactive PF, PLUS they were really present when I was overtired, and when my hormones were changing.  For instance, I work really long days on Mondays and Wednesdays, and could pretty much bank on prolapse symptoms those days, and then most of the rest of the week was fine.  And also, I quit nursing at 12 weeks, and not long after that I could tell that my body was trying to generate some sort of cycle, and that made me feel off again.  I guess this is all normal stuff with tiredness, stress, hormonal changes, and a host of other things.  I’ve also been very diligent about introducing “new” exercises into my strength training to test for a few times to see if any of THOSE generate weirdness.  So, basically, I’m just really freaking aware all the time about this stuff.

My last visit with the PT was learning how to make intense exercises – think jumping, running, and those type things….pelvic floor friendly.  How to add a PF contraction and when.  How to incorporate breathing.  My PT also said since I had good awareness and good PF and core coordination, that I was safe to begin pushing the envelope a bit and testing myself.  On a full bladder, try jumping.  Stand in weird positions and side lunges and try doing my contractions, etc.  It’s super interesting stuff.

I’m about four months PP at this point, and can tell you that each week is getting better and better.  My coordination is good with my core and PF.  My PF is beginning to do it’s job without me having to mentally think through it during every exercise, every sneeze, every lifting of the infant seat, etc.  I also still have those weird tired days sometimes where I can feel that it’s exhausted.  I’ve been working out with lighter weights for two weeks, and this week have begun increasing the load so long as that each exercise, each rep, feels good, feels coordinated with core and floor, and as long as I can pass the 3 P’s (no pain, pee, or pressure).

All in all, I would categorize working with a women’s health PT as self-care.  I had a reason to work with one for five visits.  I think every woman should visit at least once to get an assessment.  I wasn’t referred by an OB or midwife, so this was self-refer classification.  I think people should know the ins and outs of that too, financially.  Each visit was approximately $200-225, and everything except $32 each visit was covered by our insurance.  I know everyone and everyone’s insurance was different, but that’s the kind of info I wanted to know before visiting and couldn’t really find so I had no clue what to expect.  Here’s how I’m doing the math on this one – if I DID NOT go this route, I would likely be having the bladder/sling surgery (that has a 70% fail rate and/or has to be re-done every 10 years) down the road.  At who knows what cost, but also losing my ability to work for a minimum of six weeks in my profession.  So for roughly $150 out of pocket, I’m very confident in the workings of my body and managing this stuff on my own, and know what to do next if something pops up, and will likely avoid any type of surgery.  $150 feels like pocket change considering all that.

I also feel pretty strongly that even if prolapse is a diagnosis for someone, this can very much help the severity of it, or help things almost completely.  And if prolapse isn’t, but incontinence or other things are issues, this is what should be the first step – not “just accepting it as normal” or waiting until you are done having kids to have the surgery, or considering surgery as the only cure.

This is NOT a sexy topic, but it’s a necessary one.  Running a gym, I see about 60 faces a week.  During my post natal fitness certification, I learned that 50% of women deal with this stuff.  You know what?  That’s 30 of my weekly faces, and I’m one of them.  So….it’s pretty damn common, and there is a HUGELY helpful resource available that really isn’t talked about.

So I’m talking about it.  If you have questions, I’m an open book on this one…..I pretty passionate about it at this point.  So, feel free to PM me on Facebook for questions, or just to get pointed in the right direction of a PT, and I’ll do what I can to help you out!

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Fourth Trimester: Month Three


I think I’m something like 14 weeks postpartum (not gonna pull out a calendar and count, so I could be off, lol).

Time to do an inventory and let you guys know what was up in Month 3 of the Fourth Trimester!

I’m gonna write fast because I have two kids down for a nap at the SAME TIME and I’m hoping to check a few things off my to-do list, lol.

Nutritionally, my appetite is way leveling out.  But it’s still kind of nuts some days.  At week 12, I stopped nursing, so I’m not needing to eat as much anymore, and I can tell my body is starting to figure out where it needs to be.  I can also tell that my cravings and appetite are wonky many days because my sleep happens well about 2-3 days per week, and then a few days each week I’m getting less, mostly because of work and not Maren, HA!  I’ve also been feeling better not eating first thing in the morning.  I’m just not hungry then anymore, and so my first meal of the day is between 9-11AM, when it used to be 6:50AM STAT when I woke up or got done with my morning classes.  Still prioritizing a protein and produce in each meal because that makes me feel good.

Workouts are gaining steam, but still no where what I’m used to yet.  Still trying to be smart about unweighting lots of exercises.  Because I only stopped nursing a few weeks ago, I still have lots of loose joints and connective tissue (Relaxin hangs around for 3+ months after nursing).  I still also have some weak-ish pelvic floor muscles going on, and focus more on activating core and floor during each rep than I do pushing weights around.  I’m getting better at it!  I did try some single leg deadlifts with light weight last week and those were too much for pelvic floor right now.  I can do them unweighted just fine, but adding load was a little much (it was only 18 pounds dude, I’m used to doing those with like 70 pounds, for context).  Lots of half kneeling core work, side and reverse side planks, farmer carries.  Lots of unweighted squats and single leg work.  Never thought I’d say this but I’m so sick of unweighted glute bridges I could vomit, lol.

Crazy postpartum hormone wise, I’m starting to feel more and more like my old self.  Not all days, but most, HA!  I feel way more relaxed at this stage than I did with Emma.  Probably because it’s the second time around, and you sorta get an idea of what to expect and what’s going on.  And we’ve already raised one kid through four years, so we know we can at least get that far, lol.

Let’s talk about body composition though, since it’s a juicy topic for most postpartum women.  I mean, magazines tell us we should “bounce back” super freaking fast, right?  During pregnancy, I hung onto a good amount of my muscle for a long time, and then after week 30 and beyond, when lots of exercises weren’t feeling great, and I was still puking on the regular, I didn’t lift as frequently.  The loads that I was lifting were enough to make me feel good but nowhere taxing enough to stimulate muscle growth.  So, between then and now, I’ve lost tons of muscle.  I weigh a few pounds less than I did last July when I found out I was pregnant, but I look waaaayyyyyyyyy softer.  Less muscle, more body fat, even though a scale would tell you I should be smaller (but we know that the scale is only one slice of the puzzle).  Each woman is different.  Some women drop weight like a boss when nursing and after baby.  Some struggle to lose it.

Here’s how it seems to be working for me (since it’s pretty similar to when Emma was born).  The three weeks post birth, my weight drops like a rock.  Somewhat to be expected, given that an almost 9 pound baby is outside versus inside, plus fluid, blood volume, placenta, and all that stuff.  During this time I literally eat everything that isn’t nailed down because recovery from birth is no freaking joke PLUS trying to establish milk supply for a little baby takes energy.  Then, I hold steady for awhile, and my cravings level out but I still get them, and I’m kind of all over the board with hunger, plus not a whole lot of physical activity.  Then, I begin putting on some pounds again, and it usually appears to be in the form of body fat.  This time has been really no different than last time, to be honest.  That body fat part can become a mind game though.  However, I can also tell it’s leveling out and even starting to take care of itself since nursing is no longer.  My hunger is regulating, as are my hormones.  My guess is after my first cycle (boy, I’m an exciting bag of convo these days between cycle talk, nursing, and pelvic floor, lol), this will begin taking care of itself like it did last time, given I’m eating pretty nutritiously, sprinkling in my beer and treats, and also beginning to get stronger in my workouts again.  I’m not worried about it.  But I like to bring it up because I think it’s helpful for people to read that each woman will experience something different, and it’s not necessary to get nuts about diets, your body really just needs time to get back to an even keel hormonally, and that shit TAKES TIME.  I suspect NEXT July that I’ll be feeling way more like my old self.

I also use the term “old self” loosely. My self right now is just fine, but I’m kinda excited for the days when my hormones are on their old level playing field, and I’m back to a workout structure that my brain and body crave, if that makes sense.

Here’s the thing.  Your body is your body.  Growing a baby and birthing a baby and recovering from all that is a huge undertaking.  The biggest thing that it takes is TIME.  Yes, nutrition, yes strategic workouts, but TIME is the biggest player in recovery.  Self care too.  And so, in my mind, talking about bouncing back and fat loss and all that shit….is really just a ton of noise for a body that just freaking needs TIME.  I’m more after doing workouts that make my body and energy feel good, eating foods that definitely meet the health equation but also allow me to enjoy myself, and trying to just take care of my body.  And that stuff trumps fat loss fat loss fat loss right now.  Because if I feel like I want to tackle something like that, I will….when it’s TIME and I feel like I’m ready to do that. Or, I might just freaking roll on with life and not worry about that.  To each their own.

I think I’m going to continue on with the FIFTH trimester posting, and keep you guys up to speed over the next three months as well as I begin progressing more.  Oh, and I’m drafting up a bloggy blog all about my experience working with a women’s health physical therapist too, so keep your eyes peeled for that!

Fourth Trimester: Month Two

I think I’m 10 weeks postpartum. I’m pretty sure anyways, but I’m not going back to the calendar to do the math, so we will just say I’m 10 weeks, lol.

Month two of the fourth trimester.  And….I can’t remember JACK.  My memory is gone.  So is my ability to think and form normal sentences.  Yikes!  I can remember what size free weights my clients use in the gym….but I can’t remember if I ate lunch yesterday.  HA!

So, last month, I had all allllll the post birth cravings.  OMG.  Every single one.  I was hungry ALL.THE.TIME.  I think it’s to be expected….recovery from birth plus my body trying to feed another human.  I dunno, I can rationalize being that hungry anyways, because it makes sense.  I can tell you this month, cravings are not like that anymore, and my hunger has slowed way down.  I feel like I’m evening out just a bit on hunger.  Which rocks.  Our grocery bill will likely go down, lol.  Our beer bill won’t though.  Oh WAIT!  There IS something weird going on.  Beer is still good…buuuttttt, my new drink of choice lately is Roscato (red Moscato).  On ice of course, lol.

Emotionally, I would say I have all the crazy pregnancy hormones exiting the building so I’m pretty good for the most part, but have the odd crazy freak out (just ask Todd), and….while I did good with dropping off both kids at daycare for the first time, I pretty much ball when I’m feeding Maren and see her perfect little toes and her crazy antics.  Or, when I dropped off Emma at vacation bible school, and realized she didn’t need me anymore to get her name tag, and find her way to the gym with the other kids.  THAT shiz, makes me BALL like a baby.  And I would say Mama Bear comes out when we are out in public with lots of people/strangers around.  I get like nutso protective over my kids, lol.

Physically!  Here’s the Cliff’s notes from last time.  Last post, I thought I was dealing with a mild bladder prolapse.  NO!  I am NOT.  Seriously, I am thanking God on this one.  I was really freaking out about that one.  However, I am dealing with really weak pelvic floor muscles, because they are trying to be strong all the time.  I’m learning that my pelvic floor is hypertonic, which basically means the muscles are contracting ALL the time and have a hard time relaxing….I’m the walking definition of a tight ass.  Think about flexing your gunz in the mirror, and never being able to UNflex them.  That’s what’s going on here.  So, I’m working on contracting pelvic floor when necessary, but also working on relaxing it as well.  A strong muscle is only a muscle that can contract AND relax.  A constantly flexed muscle isn’t all that strong because it can’t function.  So, when I have prolapse symptoms, it’s actually because my PF needs a break and NOT because my bladder is ACTUALLY falling out.  And, apparently this shit is very common, SO, if you’ve been pregnant/birthed a baby (C-section or vaginally), I stand by my recommendation…and get yo ass to the pelvic floor PT, plz!  And STAT.

And…’s interesting what are major causes of prolapse or weak PF.  Straining on the toilet (not my issue, lol).  Excessive coughing….I did that for about 2 months when pregnant with Maren with a nasty cold.  I also puked and/or dry heaved for about 30 weeks of my pregnancy most days, so you can imagine the force that produces on one’s PF.  Here’s where it gets REALLY interesting…..forceps or vacuum delivery.  Welp, Emma was born with vacuum assistance.  And to be honest, now that I know what some of this stuff feels like that I’m working through….this has been slowly building since Emma was born.  So I’m taking this whole recovery and physical therapy thing seriously, because I want to making sure my body is REALLY recovered this time.

Also, I started workouts at about 7.5 weeks PP.  I would definitely say they feel “easy” compared to my normal, but I’d also say I’m damn proud of myself for doing what is needed right now, and dropping my ego to ease back in.  I can tell you for sure, I feel like I have NO core connection.  I can tell my core is starting to act like a core, but I literally feel like a big empty space from my sternum to my quads.  Like NOTHING is there and I have to work damn hard to make my mind connect to my core to workI do a lot of glute bridges with bands, and in a variety of positions.  I’m doing lots of upper body pulls and band pull-aparts.  Unweighted squats.  Floor presses.  And band presses.  I’m not doing any planks or push-ups because I’m respecting my core and the fact that there was a lot of outward pressure on it for some time, and I’m not going to add to that pressure in those positions.  I’m also not doing much for exercises that put downward force on my PF – no weighted squats or lunges, no deads, no swings, no overhead pressing, nada.  So, my workouts take like 20 minutes, but I can tell they are helping.  I also spend a fair amount of time each day deep breathing, and giving my PF a break, and doing some resets like rocking, rolling, and crawling.  When I sit, I make sure my posture is spot on, because that is HUGE for PF health.  I’m also trying to sit in a variety of positions – on the floor, on my knees, with legs extended, etc.  All good things for PF health.  I feel like all I talk about is pelvic floor stuff right now, buuuutttt I’m living and breathing it so it’s what is on my mind.  OH, and I walk for 20 minutes at a time, 2-3 times per day.  Walking is GREAT for PF health, but also the force on PF is a factor here, so shorter more frequents bouts are best right now.  And I still sit tons.  Because recovery, yo.

My workout buddy and I during my first week of workouts!

Also, all the cool postpartum pregnancy stuff is happening.  My beautiful pregnancy hair is GONE and now I have greasy hair that is falling out in clumps.  I had really nice skin during pregnancy and welp… we go with zits again.  And, I have way less muscle than I used to and way more body fat than I used to, which is a little bit of a mindgame, but to be honest, it is what it is right now.  I’m not one of those ladies that breastfeeds and has weight just fall off.  The whole weight thing is interesting to me.  It was a mindgame for a bit, especially during pregnancy, but it is what it is.  Through about weeks 20 or so, I lost about 15 pounds.  Which feels like a crime because you’re trying to build a human when you are pregnant.  BUT, I also spent a lot of time either feeling nauseous from food OR throwing it up.  So I’m not surprised that I lost weight of course.  Then, I put that back on, plus 8 pounds by the time Maren showed her face.  Then dropped like a rock by about 20 pounds in four days post birth after Maren was here plus extra blood and fluid.  And then I put about six pounds back on til this point.  The weight itself isn’t a factor for me…it’s just the mind game you go through like….is my baby growing….when I was losing weight.  Then, OMG, I feel SO FULL all the time, when I got that weight back plus 8 pounds.  Then, OMG I literally don’t give a shit about weight post birth as you are going through alllll the new feelings and getting used to a new baby in your family.  And then, one day you wake up and your boobs are huge (for you), you are leaking fluid from literally everywhere in your body, you literally feel a little like yourself, but not REALLY like yourself just yet, and your body doesn’t appear all that different from the outside, but it’s hugely changed on the inside.  It’s all just a big mind game is what I’m trying to say.

I went back to work last week, and I’m not gonna lie, I LOVED it.  Spending time in the gym with people I enjoy being around, ADULTS with ADULT conversations, and just feeling like I’m getting back to my purpose outside of raising humans has been AMAZING.  It hasn’t even sucked getting up at 4:15 a few times a week, because to be honest, I’m getting up at 3:30 to nurse a baby anyway, lol.  I love time at home of course, and I still get a ton of time with my littles, but being outside the house and back to work ROCKS.

And one final thing – I can honestly say that the balance between two kids has gotten WAY better.  Emma loves her sister so much, and a little one on one time from mom and day with just Emma goes a LONG way.  I still go back and forth between feeling like super mom for Maren, being a crappy mom for Emma, thinking OMG I can’t spend enough time with my littles, then OMG is it a daycare day yet, and alllll the stuff in between.  But it’s pretty awesome.  And I would also say that I don’t remember being pregnant anymore, even though I loathe it (I know that’s not nice to say, but it’s also the truth).  And 40 weeks and 5 days is really a drop in the bucket of time for the little human being that shows up (eventually) at the end.

But don’t you dare ask if we are having more kids anytime soon, because almost having a baby on the side of the road is still fresh in my mind.

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