When the Stars Align: A Pelvis Prepped for Surgery
Sometimes, the universe knows how to nudge us.
This past weekend, I hopped on a plane to visit a dear friend and colleague—let’s call her Mary—to help prepare her pelvis and pelvic floor for on upcoming surgery. She’s been talking about wanting a session for years, and it took the looming date of her bladder and rectal prolapse repair to make it happen.
And wow… we were both so glad the stars aligned, because after just two sessions the changes in her body were nothing short of amazing.
Oh—and did I mention this was 37 years after her first birth?
A Lifetime of Healing (and Some Lingering Struggles)
Mary is no stranger to bodywork. She’s an extremely gifted practitioner herself, and over the years has been treated by world-class pelvic health PTs and well-known bodyworkers across the globe. Bits and pieces healed here and there over the years since her first birth, but her prolapse remained, and the repeated UTIs finally pushed her toward surgery.
Her pelvic contraction was strong, but only the back half of her pelvic floor was engaging during contractions. She was experiencing urgency with her bowels, heaviness vaginally with the bladder fluctuating at a stage 3-4, and she was juggling pessaries in multiple sizes from 5-7 just to get by.
She shared that her sex life was good—but her cervix wasn’t always playing nice, sometimes tender and in the way.
Her Story Runs Deep
Mary’s first birth was dramatic: a distended bladder that wasn’t initially recognized inhibited her baby’s progress. The medical team catheterized her, but had to use forceps and perform an episiotomy to help the process. During baby’s extraction there was a loud crack, and they thought they had fractured her coccyx. Later testing revealed a fracture to the lower third of her sacrum near the ILA, inferior lateral angle.
Add in a major car accident in the 80s (her left side slammed against the car as she was hit at 50 miles per hour and knocked unconscious for several hours) and even a childhood fall that fractured her coccyx, and you start to see how much history her pelvis had been carrying.
No wonder her body felt stuck, misaligned, and a little defensive.
The Sessions
External Evaluation
Upon evaluation in standing, both of Mary’s shoulders were holding tension, and I could tell they were trying to weight-bear for her pelvis. In supine, her sacrum was stuck in flexion and sheered right, and her PSIS’s were very wide and immobile. Her left PSIS was more tender than her right. Initially, I didn’t think she had any ischial splay with positional palpation; however, she was lacking medial mobility bilaterally, primarily on the left side.
After mobilization of these bones, I noticed her ischial tuberosities were more narrow than most people’s. Her ribcage was still stuck upward and in expansion, and her liver, stomach and diaphragm were all restricted in mobility. Externally, her uterus was stuck on her bladder more on the left side and her left uterosacral ligament was also restricted.
Internal Evaluation
Upon internal evaluation, bilaterally her levator ani muscles were super strong. The more superficial muscles near the perineal body were not responsive. Both her external and internal anal sphincter muscles were open and while there was active strength there was no resting tension in the muscle. Her bladder position internally wasn’t sagging, but supported in supine. There was tension in the left side of her bladder and her left uterosacral ligament was restricted. Her cervix was really hard to the touch and felt off to the right with what felt like a retroverted uterus. She did report that she had fibroids in her uterus which I thought I could feel posteriorly and superiorly to her cervix. We did the trauma release statement for the cervix and recognized the uterus didn’t know that the first birth was over.
I then focused on the pelvic floor muscles. After resetting the levator ani muscles with ischial compression, I assessed the anal sphincter muscles and surrounding tissues to see how best to support them. There were several knots in Mary’s sphincter. The ischiorectal fossa was restricted more on her left side, but there was more scar tissue on the right side and at the site of her episiotomy.
In my initial assessment, I was concerned she may have a muscle defect (where the muscle has torn away from its attachment), but after working with all these structures I found this was not the case. I believe it was the scar tissue from the episiotomy that was keeping the superficial muscles from contracting. I was surprised at how much more muscle contraction was felt at the perineal body after working in this area, releasing the scar tissue, and treating the sphincter muscles.
Assessing her internally in standing to see what was happening with her prolapse, her bladder was at a low stage 2-3. I did a little bit of work on her left anterior lateral vaginal wall as there was a restriction there. She also had a slight rectocele – low, near the opening. She had a good lift of her bladder with her core contraction.
Wrapping Up Her First Session
In short, there were layers upon layers of stories written in her bones, muscles, organs and tissues. Some from birth. Some from trauma. Some simply from life.
We worked gently but deeply:
- Mobilizing her sacrum and ischium
- Freeing up her organs and diaphragm
- Releasing old scar tissue around her episiotomy
- Releasing and resetting the pelvic floor muscles
- Addressing knots in her sphincter and the ischiorectal fossa
- Helping her cervix finally realize that the first birth was over
As she was so aware of her body and knew how to help with the process of connecting and releasing what was showing up, she could feel the releases as they were happening and as we worked together.
Bit by bit, her body softened, released and realigned. She felt different just laying on the table. When she stood up after this first session she felt more balanced in her pelvis and grounded in her legs. Her pelvis felt more stable and together. Her shoulders finally stopped “doing the work” for her pelvis.
Continuing Her Work In Session Two
There were still some areas causing pain after this first session, so we had a second session the following day. We were able to address the pelvic bones that were still having mobility issues, and we even worked with her bones to release the memory of her car accident. She could feel the shifts immediately.
After her pelvis felt more balanced and was able to move more easily, it felt important to have her rebirth her first baby in a way that was smooth and uneventful through visualization techniques. Mary imagined the birth in a smoother way, and after doing so, she imagined her baby placed on her chest, and she held it while we continued her session with additional internal work.
With additional intravaginal work, I discovered the perineal body muscles were not contracting as well as they had the day before. Her transverse perineal muscles bilaterally were not contracting well either. With medial compression of the ischiums along with soft tissue mobilization to the scar tissue and surrounding muscles, Mary had much better contraction in her superficial muscles.
Also, her urogenital hiatus was really wide when we started. I mobilized the hiatus medially and she went from a large 4 finger width to a tight 3 finger separation. We gave some more love to her cervix and offered gratitude to it. We let her uterus know she was having a hysterectomy soon. It softened and Mary was able to feel content with her decision to have surgery.
She felt more support in her pelvic floor, her bladder wasn’t as descended as it has been, and it was functioning better after the two sessions. Her anal sphincter muscles were much stronger in active contraction, but they weren’t automatically remaining closed.
The Results
After these two days, her pelvic floor was engaging more completely, her bladder felt more supported, her shoulders relaxed, and her whole pelvis felt stronger and freer. I felt more confident in the muscles’ ability to handle surgery and hope the work we did will aid in her recovery.
Her words afterward?
“Thank you SO much for coming out here to treat me… my pelvis feels completely different! . . . I didn’t realize how much restriction there was still left after all those years!”
And then the icing on top…
Mary shared that after making love there were “No sore places left! And straighter. . .[My partner] says I felt tighter and smoother inside. We had so much fun!”
Yes—she was even able to make love comfortably, without pain or soreness.
Why This Matters
Mary’s story is beautiful, but it also makes me wonder:
What if she had received this kind of pelvic care right after her first birth?
What if we’d been able to support her bladder with a pessary immediately after birth? Would that have made a difference in its ability to heal?
What if her anal sphincter muscles had been guided back to full strength sooner?
We can’t change the past, but we can change the future—for our clients, for new moms, for anyone carrying old pelvic injuries into new chapters of life.
The Takeaway
The impact from Mary’s falls as a kid and her car accident had an impact on her first birth. Her example is one we can share with clients to help them understand the importance of addressing injuries in their body prior to giving birth, and ideally, prior to becoming pregnant. We just don’t know how they may impact the birth, but we can do something to reduce that potential impact by addressing them beforehand.
It is so important to spread the importance of this type of postpartum work far and wide, so all pelvic health therapists can help clients recover from birth more completely. By addressing the pelvic bones after birth and learning how to address the structures internally to maximize the pelvic floor function in fewer sessions our clients will be able to better support their families with strength, wholeness and love.
Mary’s story is proof: It’s never too late. Healing can happen at any age, at any stage, when we give the pelvis the love and attention it deserves.
About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com
Great reporting and synopsis, Detective Schulte! I just pretended my hands were on your hands to help with my own awareness, muscle memory And understanding.