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Friday Five: 5 Things to Know about Pelvic Floor Physical Therapy

By Dr. Laura Gleason, Physical Therapist and owner of Beyond the Bump Wellness

So maybe your OB/midwife/doula/friend recommended Pelvic Floor Physical Therapy (PFPT) but you are uncertain or apprehensive about what is involved. So here are 5 things to know to hopefully make you feel more comfortable with what to expect! 

1. Reasons to consider making an appointment:

Although there are many things that PFPT can help with, some common symptoms and diagnoses specific to pregnancy and postpartum include:

  • Incontinence: leaking urine or stool, problems with urgency, or constipation
  • Pelvic pain: commonly at the sacroiliac joints in the back or pubic bone in the front or anywhere around the pelvis
  • Painful sex (or pain/difficulty with any type of penetration)
  • Pelvic organ prolapse: feeling heaviness or pressure at your pelvic floor/vagina
  • Diastasis recti (abdominal separation) or not feeling “connected” to your abs/core
  • Lower back pain or hip pain that hasn’t responded to “traditional” PT
  • You delivered a baby! Even if you don’t have any current symptoms, seeing a PFPT after delivery can be very helpful. In many other countries, it is the standard of care to go to at least a few sessions of PFPT to help with recovery and screen for readiness to return to exercise. 
2. What does an evaluation look like?

You meet with a Physical Therapist and discuss the history of your symptoms, your concerns, and your goals. Depending on the issue, they will then look at your posture, breathing, how you move through your back and hips, and test strength. The pelvic floor muscles are assessed in a similar way to other muscles in the body: by checking range of motion, strength, and if there is any overactivity of the muscles or “trigger points”. The difference with the pelvic floor muscles is how to access them, and the most effective way is intravaginally. If the therapist thinks that you may benefit from an internal exam, they will discuss this with you: why it is recommended and what it will involve. If, and only if, you give consent and are totally on board, they will do the exam. 

3. So what does that internal assessment actually involve? 

First, the PT will step out of the room, and let you get undressed from the waist down with a sheet draped over you. Then they will sit or stand next to the table and insert one gloved and lubricated finger into your vagina to test the pelvic floor muscles: how well they can contract, relax, and coordinate with the rest of your deep core, and if there are any tight or tender areas. The PT will then treat what they find.

4 . Does it hurt?

You can most commonly expect it to feel like working on other areas of your body. If you have a really tight hamstring, manually working out that muscle or stretching isn’t going to be completely comfortable but it shouldn’t ever be too painful. Similarly, with the pelvic floor, if you have some tightness or scar tissue that needs to be worked on, it may be tender. If it is ever too painful, you should absolutely tell your therapist.

5. How many times do I need to go and what happens in between sessions?

This really varies depending on each person. Sometimes people just need a session or two for some re-education of the pelvic floor muscles, and sometimes it is necessary to come for much longer if there was a very physically traumatic birth or long-standing symptoms for example. Most commonly, you can expect to come about once a week at first and then space out appointments more as you improve. Your therapist will likely give you things to work on after each session. This may look like exercises, tips for body mechanics, advice on how to work on your own scar, etc. You will have an active role in your own recovery.

If you are pregnant or had a baby weeks, months, or even years ago, PFPT can be very effective at decreasing symptoms and improving your quality of life. 

Dr. Laura Gleason is a PT specializing in pelvic floor and orthopedics. She is the owner of Beyond the Bump Wellness, which provides workshops and guidance for pregnant and postpartum people. She sees patients at Chicago Physical Therapists. You can also follow @beyondthebumpwellness on Facebook and Instagram or email laura@beyondthebumpwellness.com.

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