I’m thankful for the internet and social media because it brought the subject of pelvic floor therapy to my attention before I had my son. I wasn’t quite sure what it was, but I knew that it was vitally important postpartum. In fact, pelvic floor therapy is a standard part of postpartum care in Europe, often covered free of charge under their health care system. The U.S. hasn’t caught onto this trend and that’s a real disappointment. Many women I’ve talked to haven’t heard of it and therefore haven’t gotten the rehab they need after having a baby.

I didn’t have a lot of significant issues following Miles’ birth, but I still wanted to be evaluated to know where I stood postpartum. I became so interested in the lack of discussion postpartum that I’m currently finalizing my certification as a postpartum corrective exercise specialist, something that I will also cover in detail once I complete it.

I recently wrapped up my own pelvic floor therapy and in combination with discussions with my PT and knowledge from my training, I think this is a good overview of pelvic floor therapy. Please let me know any questions you may have in the comments!

What is the pelvic floor?

The pelvic floor refers to a group of muscles that effectively form a sling to hold your uterus, bladder, and rectum in place. They stretch from your pubic bone to your tailbone and in addition to holding everything in place, they form attachments to many other parts of the pelvic girdle and assist in stabilization and mobility.

Things like childbirth or anything that puts a strain on these muscles can lead to pelvic floor dysfunction. This includes, but is not limited to:

• urinary or fecal incontinence
• organ prolapse (drooping or descending of organs)
• sexual dysfunction
• hip pain associated with weakened pelvic floor muscles
• diastasis recti (separation of abdominal muscles)

Who needs pelvic floor therapy?

According to the NIH, nearly 24 percent of U.S. women are affected with one or more pelvic floor disorders.

For one, I think that every woman who has had a child should at least be evaluated by a pelvic floor PT. This includes both vaginal and cesarean deliveries. Because I didn’t deliver vaginally, I didn’t have quite as many issues as I could have had, but a) I wanted to be checked out anyway b) I learned proper breathing techniques to help activate the abdominal muscles that loosen during pregnancy and c) I was able to get help with scar mobilization — something that is crucial for women who have delivered via cesarean.

Secondly, pelvic floor therapy is not only for postpartum women, although these make up a large percentage of patients. Both women and men (yes, they have a pelvic floor too) having issues with incontinence due to age or other factors and women who have issues with pain during intercourse can also benefit from pelvic floor therapy, to name a few.

Why do I need pelvic floor therapy?

I think the real question is why DON’T you need pelvic floor therapy. To think that we go through the physical trauma of childbirth with little to no follow up is a scary thought. Your pelvic floor muscles have been stretched and weakened, followed by birthing a child that can result in tearing and prolapse. Getting an exam is important to make sure that everything is functioning correctly and if not, how to fix it. Even with little to no symptoms, it’s important to learn exercises and breathing techniques to ensure that nothing pops up down the road.

You may be asking — can’t I just do a bunch of kegels instead? Yes and no. There are both weak and tight pelvic floors and both can cause dysfunction. Doing an abundance of kegels if you already have a tight pelvic floor can do more damage. This is where breathing and relaxation techniques are imperative to restore normal function. It’s best to have a professional assess what group you’re in.

What happens during the appointment?

Each case is different, but all cases begin with a verbal discussion of your medical history to date. I spoke with my therapist about my delivery and how I was currently doing.

The easiest way to see what is going on is with an internal exam. The therapist will use a gloved finger to examine what’s going on internally and it’s actually really fascinating to hear about if you feel like talking to them about it as it’s happening like I did (HA). Think a trip to the gyno but without the uncomfortable speculum and a little more poking around. I was asked to do a kegel along with some breathing techniques to evaluate my strength around that and by examining internally she was able to tell that my left side is tighter than my right which could lead to some muscle imbalances in the future.

Following the internal exam, I had to do some breathing evaluations and my hip strength was tested to see how everything was functioning together. We developed a plan of care and because I wasn’t experiencing any leakage or prolapse, the regimen was fairly light.

As I mentioned earlier, we also worked a lot on scar mobilization because mine was pretty tight. Mobilizing the scar allows you to free up and prevent any adherence to underlying muscle tissue or organs, which can also lead to dysfunction. My scar is directly over my bladder, so allowing it to remain tight and immobile could lead to urinary issues. While I can work on it at home, my therapist was also able to work on it externally AND internally, which helped loosen it up.

When should I start?

If you’re having issues or pain while still pregnant, you can schedule a consult with a pelvic floor PT. It doesn’t have to be only after you’ve given birth.

Following childbirth, it is recommended that you typically wait about 6 weeks to give your body a chance to start healing.

Is it too late to see a therapist?

It’s never too late to see a pelvic floor therapist. Because pelvic floor issues can result from things non-pregnancy related such as age or chronic constipation, there’s never a point where therapy is futile. If you’re having issues, make an appointment!

It’s also important to add that issues can occur later on even if they aren’t present initially. Things like starting exercise too soon and putting too much pressure on the pelvic floor can lead to dysfunctions if you’re not careful. If this happens, make sure to find a therapist in your area to learn what things you should and should not do.

Where do I find a pelvic floor therapist?

My OB basically rolled her eyes at me when I asked about therapy because she assumed that my one kegel during my 6-week checkup meant that I had nothing wrong with me. Hopefully yours is more receptive, but if not, don’t be afraid to advocate for your health! Many OB/GYN offices will have therapists that they can refer you to, which is important if your insurance requires a referral.

Another way to find one is to check with your insurance to see who is covered. Either check the insurance website or call them directly which may be faster.

Simply searching online for “pelvic floor PT” and your city should bring up practitioners in your area. I also asked for recommendations from people nearby who I knew had gone after having a baby.

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If you have any questions about pelvic floor therapy, feel free to drop a comment below. I hope this helps!