Women Ask Wednesday: What’s pelvic floor physical therapy?

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Happy hump day! Today we get to chat about one of my favorite interventions for women – both outside pregnancy/postpartum or during pregnancy/postpartum periods. We’re talking pelvic floor therapy! Are you already doing your Kegels now? Let’s do it!

What is the pelvic floor?

Your pelvic floor is a group of muscles at the bottom of your core. The muscles stretch across the bottom of your entire pelvis! This 2 minute video offers a great little visual!

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What is pelvic floor physical therapy?

Pelvic floor therapy is physical therapy aimed at the pelvic floor. The goal is to improve the strength and coordination of the pelvic floor with both external and internal exercises in your normal, day to day activities.

What conditions can pelvic floor physical therapy improve?

  • Bowel incontinence
  • Diastasis recti
  • Dyspareunia (painful sex)
  • Fibromyalgia
  • Musculoskeletal dysfunction
  • Pelvic pain
  • Postpartum concerns (back pain, incontinence, painful sex)
  • Pregnancy
  • Urinary incontinence (leaking urine)

Is physical therapy recommended during pregnancy or the postpartum period?

YES! Physical therapy can be done almost any time during pregnancy and during the postpartum periods!

The American College of Obstetricians and Gynecologists recently acknowledged physical therapy as a component of postpartum care in their 2018 Committee Opinion (Number 736):

Although the recommendation doesn’t include a referral for diastasis recti, dyspareunia, or pelvic pain, these are generally appropriate referrals. If you have questions, please discuss them with your provider at your pregnancy, postpartum or well woman visits.

What exercises can I do during pregnancy or postpartum to help my pelvic floor?

Check out tips on Exercise During Pregnancy (love their fact sheet at the bottom of the page but there’s not a direct link). Or, listen to a podcast here about:

  • Precautions in pregnancy from normal musculoskeletal changes
  • Positions in pregnancy to avoid
  • How to help with low back pain in pregnancy
  • Safe exercises during pregnancy
  • Starting or maintaining a fitness routine in pregnancy
  • Being strong prior to delivering your baby (hint: it makes for an easier delivery and faster recovery!)
  • Waiting 4-6 weeks postpartum BEFORE your start back into exercise postpartum

Also this video addresses low back pain during pregnancy:

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That all sounds great. What’s a Kegel and when should I perform one?

A step by step guide for how to perform a Kegel exercise (or to check you technique) is here.

Or check out this video here (Australian accent is a bonus…):

My experience with pelvic floor therapy…

After my son was born in December 2018, my pelvic floor didn’t feel the same. I felt weak and a little uncoordinated. I started back to exercise around 6 weeks postpartum but still felt tired and a little unbalanced. Because my son came super fast (read his birth story here!), and I had another second degree tear, I was eager to complete postpartum pelvic floor therapy. This therapy was covered by my insurance and it was one of the best decisions I’ve ever made!

I spent a total of 3 months in pelvic floor therapy. Initially, I went twice a week for a month, then weekly. I learned all kinds of information about my pelvic floor, how to NOT pick up children (or their toys), posture, strength training and every way you can do a Kegel imaginable! I had a grade 2 cystocele (bladder prolapse) when I started the therapy and no cystocele when I completed the therapy. Bless my physical therapist too – she was amazing and I must have asked her hundreds of questions. Since completing the therapy myself, I offer it to almost every woman at her postpartum visit and any woman in pregnancy with significant sciatica or back pain that isn’t relieved by normal interventions.

Looking for a pelvic floor therapist? Make sure you seek out the right kind of provider. Remember, a pelvic floor physical therapist has had specialized training for pelvic floor care! Find a provider here and here.

Want more? Check out these resources:

Hope you guys learned a little about the pelvic floor and how physical therapy can help. Let me know your questions and happy hump day!

Jamie


References

American College of Gynecologists and Obstetricians. (2018). Optimizing postpartum care. Obstetrics & Gynecology, 131, e140-50. Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care?IsMobileSet=false

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