All About: Pelvic Floor Physical Therapy

If you’re an expecting mom, I bet you’ve prepped the nursery, packed your hospital bags, read books, and made it to all of your prenatal appointments. But have you considered the state of your pelvic floor both before having your baby and after? While birth is a natural process, pregnancy and delivery are both traumatic for your pelvis, pelvic muscles, and organs.

Healing your pelvic floor after birth is so important (as is prepping it before and during your pregnancy so that you can minimize the damage), but so is strengthening all of the muscles so that they can return to optimal function. Common symptoms of pelvic floor dysfunction are: incontinence (urinary and bowel), organ prolapse, painful sex, constipation, diastasis recti, and bladder pain. Many women will see a physical therapist and have complaints of: neck and back pain, sciatica, pelvic pain, tailbone pain, a lot of which can be the result of postural changes that come with nursing, carrying your baby, wearing your baby. They may also just feel weaker, have problems connecting with their pelvic floor, or how to return to exercise without causing further pain/injury to their pelvic floor.

Fun fact: did you know that in Europe, it is customary for a woman to be referred to physical therapy if she reports any pelvic floor dysfunction at her 6 week postpartum visit before they return to work, sex or exercise? We are behind the times here!

At your 6 week postpartum appointment, your physician will typically assess your uterus and cervix for healing but will often ignore the pelvic floor muscles. A midwife will usually assess the strength of your pelvic floor muscles and are more likely to refer you to pelvic floor physical therapy. This is why it’s so important to advocate for yourself! Remember that just because something is “common” doesn’t mean that it’s normal pelvic floor function and shouldn’t be treated. Since these symptoms are not life threatening, most women will let things like urinary incontinence (peeing when we sneeze/cough/laugh) go undiagnosed and untreated, suffering in silence waiting for the symptoms to improve or go away. This is not always the case, unfortunately!

My personal experience:

I’ll share a little about my personal story and why I decided to see a physical therapist. I’ve had 3 children and did not decide to see a pelvic floor physical therapist until after having my last child, though I should’ve both before and after every single one of them! My first child was not in a good position during his labor/birth likely because my pelvis was not in a good position. This led to a very long labor for me plus 4 hours of pushing (and tearing + stitches). I did not have any incontinence issues or pain after healing, so I continued on with life. During my second pregnancy I saw a chiropractor to hopefully avoid another long birth and pushing stage. I also did perineal massage for the last 4 weeks to break up scar tissue to hopefully avoid tearing again. Everything mostly worked, but my labor was still longer than I expected. I did not tear though so I was very thankful for that! However, I did experience a little bit of urinary incontinence when exercising (and probably other tasks that just went unnoticed/shrugged of). Yet I still didn’t seek out physical therapy. Cue the birth of my third child who was much larger (unsuspected) than my previous two kids. He had shoulder dystocia which resulted in a broken humerus for him and suspected nerve damage for me from the acts of getting him out safely.

At my 6 week postpartum check with the midwife that delivered him, she did an exam and suggested pelvic floor physical therapy. I knew I wanted to see one though since it was my last child and I wanted to return everything to optimal function! Thankfully I do not have any nerve damage, but the position of my pelvis was causing my a lot of pain when I sat for extended amounts of time. I also have weakness in my pelvic floor muscles as well as difficulty making that connection with my pelvic floor to make things “work.” There’s definitely some mind + body work that needs to happen!

My first appointment consisted of a posture check, pelvic alignment check, and internal pelvic exam. I was also assessed for diastasis recti and taught how to truly connect to my core as that is an important part of your pelvic floor. Even though I had seen a chiropractor for both pregnancy 2 and 3, I have never had a more thorough pelvic alignment check! Not to mention that I was pain free that very day after getting everything back in the right place. Don’t be alarmed by the internal exam; if you have a good therapist, it will be the most gentle thing you’ve ever experienced.

So who should see a pelvic floor physical therapist?

Everyone! Pregnancy and birth are traumatic events so it doesn’t hurt to have a “tune up” so to speak and make sure that everything is working as it should. Undiagnosed or untreated issues rarely go away on their own and can actually worsen with age. So much of the pelvic floor is connected to other parts of our bodies by fascia that pain can start to manifest outside of the pelvic floor and once the pelvic floor issues are resolved, the other pain will resolve as well.

Most people will only need a few sessions of physical therapy and then will receive a home exercise program to continue addressing the root cause of their symptoms. I asked my physical therapist if there are any issues that she wouldn’t be able to resolve and she said it was a very short list of things that she would not be able to improve or wouldn’t improve using a multi-disciplinary approach (such as a urologist for example.) She does not often have to refer people to surgery so that is a good sign that most of our “common” ailments after childbirth can be easily reversed!

Is it covered by insurance?

This will depend on your specific plan and physical therapy benefits, but usually yes! However, you may have to pay out of pocket and file it with your insurance yourself if your provider does not. You can also use your health savings account to pay for services.

What will your first appointment look like?

Most pelvic floor physical therapists will begin with an extensive intake to learn about your prior activities, current issues, lifestyle, and goals. They will also educate you on pelvic floor anatomy, behavioral modification to decrease symptoms, core strengthening, and breathing mechanics. An internal exam is not always necessary if you’re uncomfortable with that. They can use a variety of treatment techniques like myofascial release, trigger points, biofeedback, improving muscle tone, and improving your pelvic alignment.

How do you find a pelvic floor therapist?

One, ask for recommendations from personal connections. You can also ask in a facebook group. Next, you can check the women’s health section of your physical therapy association for your state. Finally, pelvicrehab.com is a great place to search for a local physical therapist.

Pelvic floor physical therapy after an event like childbirth just makes sense. You wouldn’t run a triathlon without training, stretching, resting, icing, etc so new moms should also heal those strained muscles since childbirth may be the most strenuous event for her body in her lifetime!