Yes, Pelvic Floor PT is Real

and a Much-Needed Specialty

September 15, 2022

All I have to do is look at my daughter, Molly, who is eight months pregnant with her second child—a boy!—to remember way back to those third trimester challenges. Even though I had a much bigger “beach ball” under my dress than she does (not a competition, but I win), Molly still reports the following conditions: she can’t see her feet when standing up; she has a hard time getting on her shoes, let alone tying her sneakers; and sitting close to the table to eat is nearly impossible because of the “shelf” under her chest. But the worst is the pressure on her bladder. She needs to pee a lot, and, on occasion, she leaks when she sneezes and coughs. Ohhhhh, what a joyful mother daughter bond we share—except she’s very pregnant now and I, thankfully, am not.

Yet I’m the one with prolapse caused by damage to the supporting muscles of the pelvic floor during childbirth. So that urgency to pee, that leaking from a sneeze or cough, led me to do pelvic floor physical therapy several times in my life. Once after delivering Eric, once after delivering Molly, then again in the late spring of 2021. Methods have changed, but the hoped-for results remain the same—regain bladder control.

There is so much more to pelvic floor PT than learning to do proper Kegel exercises. (Allow me a brief food writer’s digression!  It’s important to note that Kegel is very different from kugel—the traditional Jewish dish which I adore. Kegels help strengthen our core muscles, kugel maybe not so much. My mother and grandmother made fabulous renditions of kugel.  As I am a food writer at heart, it seems only fitting that I share my best friend’s recipe at the end of this essay, with a tip of the hat to Nora Ephron.)  Now back to pelvic floor PT!

This time around (in 2021), the PT methodology I learned focused on the whole being, not just the isolated pelvic floor. I learned relaxation exercises, diaphragmatic breathing, mindfulness exercises for my posture when sitting and standing, and a whole slew of strengthening exercises involving slow contractions and gentle releases of the pelvic floor muscles—all aimed at urge suppression and control. My mantra when I felt the urge to pee was to say to myself, “I’m in charge, this is not an emergency.” (Easier said than done when stuck in traffic after brunch with a friend that included several cups of coffee. Or that memorable time in France, returning to our hotel room after a spectacular dinner, when the zipper on my pants got stuck. That was a major fail, and so were those designer pants … forever.)

Of all the exercises I learned and practiced, the one that felt completely new and very effective was contracting the muscles at the front of my pelvic bone so that whether standing, sitting, or in a supine position on the floor or in bed, I could “nod” my clitoris towards my rectum as if I was capturing a drop of urine. That nodding motion, a gentle pulling back and contraction of those front pelvic floor muscles, was the biggest help to stop the flow of urine. It requires a tightening and then releasing, not a constant hold.

This exercise is very different from a Kegel. A proper Kegel, as I was taught, meant using the labia to lift an imaginary object into the vaginal canal. When sitting, it means lifting the perineum and vagina away from the chair. It took a lot of practice and mindfulness to finally build self-trust and believe my new mantra that “I’m in charge.” I learned that many of these exercises could be practiced anywhere! So next time you’re waiting in the check-out line at a grocery store give it a try … I do. 

And now the bonus recipe! Perfect for the upcoming Jewish holidays.

Harriet’s Kugel

For years, we have shared Thanksgiving and many Christmas’s with our closest friends, Harriet and Peter Watson, and their children. Harriet always made a noodle kugel for the holidays, so that tradition became a part of the Morgan family tradition, too. The question was, which noodle kugel did we make? My mother’s recipe for noodle kugel, which I grew up eating and loving, was made with eggs, sugar, cottage cheese, sour cream, vanilla, and crushed pineapple. My daughter, Molly, loved mine until she tasted Harriet’s and declared hers far superior. So, this is Harriet’s winning recipe. Don’t bother to substitute low fat anything in the kugel. This recipe is meant to be rich and scrumptious.  I’ve always thought a dollop of sour cream on top was gilding the lily, so to speak, but it’s tradition, too.

Serves 12

1/2 pound extra-wide egg noodles

7 tablespoons butter, melted

6 large eggs

1 teaspoon kosher salt

1 cup granulated sugar

1 pint (16 ounces) small curd cottage cheese

1 1/2 cups sour cream, divided

15 ounces ricotta cheese

1 (3 ounce) package cream cheese, at room temperature

2 cups milk

1 cup golden raisins

2 tablespoons ground cinnamon

Preheat the oven to 350°F.

Fill a medium saucepan two-thirds full of water, cover, and bring to a boil over high heat. Add the egg noodles, stir, and cook until al dente (cooked through but still slightly chewy), about 8 minutes. Drain in a colander and then transfer to a medium bowl. Toss the noodles with 6 tablespoons of the melted butter and set aside. Use the remaining tablespoon of butter to grease a 9-by-13-inch glass or porcelain baking dish.

In a large bowl, beat the eggs and then whisk in the salt and sugar. Using a silicone spatula or large spoon, add the cottage cheese, 1 cup of the sour cream, ricotta cheese, and cream cheese and mix until combined. Add the milk, raisins, and noodles and mix gently until thoroughly combined.

Pour the mixture into the prepared baking dish. Sprinkle the top generously with cinnamon. Bake, uncovered, until the kugel is set and the sides are lightly browned, about 1 1/2 hours. Cut the noodle kugel into 2-inch squares and transfer to a warm serving platter or serve directly from the baking dish. Serve immediately, or keep warm for up to 1 hour. Place the remaining 1/2 cup of sour cream in a small bowl with a spoon so your guests can put a dollop of sour cream on top of the kugel. (The kugel can be made up to 2 days in advance and reheated, covered, in a 250°F oven.)