Written by Shraddha Wagh, PT, DPT, PCES
“Everyone tears when giving birth. If I tear the first time, it’ll probably happen each time after.”
“Back pain and hip pain are normal during pregnancy. I can barely get out of bed and walk, but a couple more weeks until I deliver and then I’ll be just fine”
“Of course I leak a little every time I cough, sneeze, or exercise- I have 3 kids!”
“I guess I’m just getting old, so pain with intimacy and urinary leakage probably go hand in hand with that”
Above are just some of the commonly expressed concerns by women prior to trying pelvic floor physical therapy. Although the symptoms and concerns above are very common, they are not normal. It is no surprise that women play a crucial role in societies and households, but all these responsibilities often take time away from 1 thing: taking care of their own bodies.
The pelvis is the core of our body. Your pelvis – or 2 hip bones – are connected to your spine, core muscles & hip muscles. Strength in all these areas is needed for functional activities such as walking, lifting, and bending, but also for bowel and bladder function. Many symptoms of pelvic floor dysfunction can be difficult and embarrassing to talk about, but they CAN be treated and managed.
Below are some of the conditions that pelvic floor therapy can help:
- Pain with intimacy – also known as vaginismus or pelvic floor muscle spasms
- Managing pain during & after pregnancy, eg sciatica, pubic pain
- Childbirth prep & reducing risk of perineal tears
- Urinary leakage or retention
- Constipation and/or diarrhea
- Low back pain or hip pain
- Core weakness or separation of ab muscles- also known as diastasis recti
- Painful menstrual cycles
- Endometriosis
- Interstitial cystitis
- Pain after c-section
What is the pelvic floor?
The pelvic floor is a group of 3 layers of muscles that sits like a sling between the pubic bone in the front of our body (where the 2 parts of the hip connect) and the tailbone. The pelvic floor muscles help with stability, reproductive function, support, and sexual function. If these muscles are too tight or too weak (or both), they can cause some of the symptoms listed above.
Common Misconceptions About Pelvic Floor Physical Therapy
You must wait until after pregnancy
- It is recommended to see your pelvic PT in your first trimester for baseline measurements, and then as needed based on individualized recommendations. For childbirth prep, it is recommended to see your pelvic PT around 32 weeks.
It is not beneficial after giving birth
- Seeing a pelvic PT postpartum is just as important as the 6 week follow up with your OBGYN! Pelvic PT can help you with any pain or symptoms after giving birth and teach you proper mechanics so you can lift and play with your baby without any difficulties.
You will always have internal vaginal and/or rectal each session
- Pelvic floor PTs are specialized and can perform an internal pelvic exam to assess the tone, strength, and endurance of pelvic floor muscles. If necessary, the procedures will be outlined and explained in detail. However, internal work is not always needed- your PT will work with you based on what you’re comfortable with.
You can wait until you have pain or symptoms to see a pelvic PT
- Prevention is key! Why wait until you are experiencing leakage or unable to move the same as you did before. Treating something before it has the chance to progress is easier, quicker, and saves you pain!
I can just do kegels at home
- Kegels- or pelvic floor contractions- are commonly assumed to be the key to solving all pelvic floor issues. In some cases, kegels can actually increase symptoms and may not be the answer!
What to Expect at a Pelvic Floor Evaluation
Once you’ve decided to attend pelvic floor PT or have been recommended to it by a friend or doctor, now what? The first session will involve a combination of questions & movements in different positions. Your PT will take a detailed medical history that will include questions about bowel, bladder, and previous pregnancies. Based on the history, the PT will then perform a physical exam that looks at posture, strength, range of motion, and coordination. If warranted, you may need a pelvic exam. The pelvic exam is split into 2 parts: external and internal. The external exam will allow your PT to see your coordination: can you perform a kegel? Can you bear down correctly? The internal exam is performed with 1 finger and water-based lubricant (no speculum or instruments!) to check the pelvic floor muscles for tension, strength, and endurance. At the end of the session, your PT will discuss these results with you and come up with a plan to address your concerns. Contact JAG PT today to schedule an appointment!