What is and what all goes in to pelvic floor physical therapy?

Pelvic floor physical therapy is a subspecialty of orthopedics, in my opinion. Therapists have the knowledge of the muscles, fascia, ligaments, and anatomy of the core, pelvis, hips, spine, and abdominal contents and how it all works together.

Pelvic Floor Physical Therapists have an extra certification to perform internal pelvic floor assessments. This allows us to determine your control, strength, tone, tenderness, endurance, and coordination of the pelvic floor muscles. Your pelvic floor muscles are in charge of your pee/poop, sex, support your organs and stabilize your pelvis. They are commonly injured with childbirth but can also have injuries from falls, accidents or traumas but even some have pelvic floor issues prior to pregnancy/delivery. MEN can also have pelvic floor issues.

An evaluation with a pelvic floor therapist is not much different from any other therapist at a clinic - we look at movements, strength, posture, alignment, breathing, range of motions and check on the structures around your body. I love to look at functional things like: squat, single leg stand, bend, reach, breathe, and stand or sit. We talk extensively about your concerns, goals, fears and often try to minimize all the misconceptions that are out there on prolapse, diastasis recti abdominis, leaking, urgency, scars, and other related things to the pelvis.

An internal assessment can be performed on a patient if consent is granted. This generally is MUCH more gentle than what you'd think about in an OB/GYN office. You are completely in control the whole time. You are under a sheet and covered rather than hanging out on the edge of a cold table, legs sprawled and exposed. I do a lot of explaining as we continue with each client to make sure they client is comfortable with the situation. (I will say that NOT every needs an internal assessment if you are having symptoms - some individuals will get better without having to be assessed if we address the right issues).

During the assessment, the client is under a sheet but the sheet is pulled upwards to allow us to visualize the pelvic floor region. A single digit is used to palpate (feel) the muscles of the pelvic floor. A LOT of communication is offered to help the patient know what is being performed - there are 3 layers of muscles so we gently assess all three. We might check the client for a strong contraction (Kegel) to check strength and hold time (endurance), quick contractions, cough check (we call this the knack if your pelvic floor contracts well during the cough and doesn't bear down), bearing down (like you're pooping), sensation, sensitivity, reflexes, trigger points, pain, tissue tension, scars and skin color. I have also been able to assess patients in standing to see what their pelvic floor muscles are doing with movements if they have issues with running or squatting etc.

Once you are assessed - we determine a plan of care to get you back to your goals. It may be 1 time a week or up to 3 to truly gain strength and functional control.

every mom deserves postpartum care…to allow them to reach all their priorities.

Can you explain why it's so important for moms to have pelvic floor physical therapy after giving birth?

I find that most moms are not taught about the common issues we have after childbirth.

Statistically speaking, supposedly up to 50% of us have a prolapse, 1:3 have incontinence, and 34% of us have a diastasis at up to a year after delivery!

All of these things can be affected by what happens in the pelvis.

I often find that the pelvis itself (think hip bones) are not aligned well after delivery. This puts more torque on the tissues or muscles that have just been traumatized by a delivery, C-section or pregnancy. Just because you did not delivery vaginally does not excuse you from pelvic floor issues. Though C-secions can lower the chances of prolapse, pelvic floor issues can still happen!

Also think about the growth the baby had on the system itself - the ribs had to expand, the belly expand, the pelvis changes shape often, spine can change in alignment and muscles are constantly under load. Then, all of a sudden, a baby comes out and everything is expected to just move like before expect that it all has stretched and now slightly recoiled. Its all just trying to find its new normal.

It takes us 10 months to grow the baby then immediately we are expected to bounce back because society make it look like that...

I find that if we can address the little issues early on (alignment, strength, strategies with lifting (like not holding your breath, activating the deep core and hip hinging) or releasing tight structures) SO MANY things can be prevented within the first year and definitely throughout our lifetime.

Medical providers at your 6 week check up are generally looking at the scar site, talk about birth control, and screen for depression. Personally they never checked my belly muscles, checked for pelvic floor issues or a prolapse. Though they may know what that is...I don't feel that they generally routinely screen for these things. That is why it is important to see one of us!

The psoas muscle is often tight - release work can be incredibly helpful!

What is incontinence and how can pelvic floor therapy help?

There are a couple different kinds of incontinence. Two of the most common are stress incontinence or urge incontinence.

Stress Incontinence - this is when there's a quick increase in pressure through the abdomen and the pelvic floor muscles are not ready to respond and hold the urine in! The bladder being in the abdomen gets a quick increase in pressure and pee just squirts out!

First of all, we need to make sure this is the case and that you in fact have the symptoms for stress incontinence. We have seen some ladies to leak who have an overactive pelvic floor (muscles that don't relax) so when they are asked to fire - they are already working too hard to help hold the pee in. Often these ladies have urge incontinence where the sensation of having to go gets so strong so quickly that they leak.

Pelvic floor therapy allows us to determine your strategies and see how we can change those to keep you from leaking. Sometimes it is just as simple as increasing the pelvic floor strength by kegels. Sometimes it's a coordination thing where we have to help your body learn WHEN to fire. Sometimes it is a hip and gluteal weakness - get your booty stronger! Sometimes its keeping you from holding your breath! Most of the time it's little bit of all of the above.

I find that a lot of us are not "in tune" with our pelvic floors. We don't really know what we're doing and definitely don't know if we're doing something right.

In fact, statistics are as high as 50% of us are doing the Kegel wrong.

Why is this important? Because, if we are doing it wrong - we could be feeding into the problem and not helping it.

Any leaking at all is incontinence…and it’s not “normal”.

How frequently should moms go to get a physical therapy session after baby?

Most of the time we hold off until the 6 week check up to start therapy. I would recommend, however, to start as early as you can with your exercises.

What exercises?

Well, if you see a pelvic floor therapist before delivery, you will know!

Breathing is a great pelvic floor exercise. Walking is too. Gentle movements can help the pelvic floor heal better just like if you were to see a therapist for a knee surgery or ankle injury, the sooner we get the body moving gently the better. I would recommend moms doing homework daily or at least every other day. You may not be ready for a heavy regimen so I like to see my moms 1-2 days a week.

We can help with that alignment and the pain of sleeping in weird positions with a new baby. The better you sleep, move and function - the better you will feel!

Click this link to see my 4 tips EVERY mom needs to know

How long does it usually take to get your body back to normal after pelvic floor physical therapy?

Whew! This is a loaded question. I would love to reframe this.

We will have a new normal.

That is a myth - you will just "bounce back" and any program that portrays it to be that easy is likely a hoax. Not that you cannot do what you always wanted, but you may need to do it a little differently - Just for now. It honestly is a continuum of healing and strengthening. I generally state 18 months to 2 years with the consistency and compliancy in a training program for most of us to feel our "normal". We all have different variables like any tearing, prior pregnancies, pain, hormones, nursing, ability to strengthen during or before pregnancy, and genetics. There is no one size fits all and we all are different and complicated...can I get an AMEN?

What are some other ailments that pelvic floor physical therapy can help with?

Pelvic Floor Physical Therapy can help with

back pain,
pelvic pain,
abdominal pain,
diastasis recti,
sciatica,
pelvic girdle pain,
pubic symphysis pain or dysfunction,
leaking (pee and poop) REMEMBER any leaking is a problem - its not just "the new normal" you should put up with,
pain with sex,
prolapse symptoms,
urinary frequency or peeing too much,
constipation,
prenatal education on perineal massage and positions for better labor and delivery
...and the knee bone is connected to the foot bone so we see plantar fasciitis, knee pain, hip pain, and all sorts of headaches/neck pain and rib pain too...
Basically anything you can't seem to figure out on your own and you just feel is off.
I would also say that if you are constantly seeing a chiropractor or another provider and your "pelvis keeps going out" or your back keeps going out - you need to strengthen and improve control. Your bones don't like to stay put when the muscles are not strong enough to hold them there. You may need another set of eyes and a physical therapist is one of the best options :)

So many things we can improve with physical therapy…

Is there anything else you'd like to share about pelvic floor physical therapy?

It is not scary. Most of the therapists who are in this field have our own story (generally success stories) with pelvic floor therapy. We are a very passionate bunch and are super motivated to help our patients recover faster, better and not endure the things our parents and grandparents have had to go through because they lived in silence or embarrassment.

You are valuable.

Your body is strong, capable, adaptable and resilient.

We just have to show you how much it is!

What is Pelvic Floor Physical Therapy? Why do ALL moms need it?