Why Should You See a Pelvic Health Therapist While Pregnant or Postpartum?
My name is Dr. Mora Pluchino. I am a physical therapist with extensive additional training in the specialty areas of pelvic health and pediatrics. I have been practicing physical therapy since 2009, which feels like a blink of an eye and forever at the same time. I went to college with Katie Roeder, the owner of Happily Ever After Sleep Consulting, and have been watching her business help my friends and patient’s’ babies since she began coaching on sleep. Katie asked me to share with her audience what pelvic floor therapy is, and why a person would seek out pelvic floor therapy in relation to her clientele, which is new parents, during and after their pregnancy.
What is Pelvic Floor Therapy?
There is a specialized type of therapy called “Pelvic Floor Therapy.” Physical Therapists (PT) and Occupational Therapists (OT) can do this type of therapy. PTs are the musculoskeletal movement experts. OTs are the functional and activities of daily living experts. Both have different skills to help a person return to normal movement and function. Pelvic floor therapy is a specialty area that works on areas like the belly, ribs, back, and in the pelvis. A pelvic floor therapist can treat all the traditional things like back pain, movement issues, and postural stuff, but also brings in extra skills to work on things related to bowel, bladder, and sexual function.
This is very often the time clients say things like:
“I never knew this existed.”
“Why did no one tell me about this sooner?”
“I thought I just had to have surgery or take medicine for my issues.”
“You’re going to look at WHAT part of my body?!?!”
A pelvic health therapist is an expert on the abdominal canister. This means our entire torso. The abdominal canister is a pressurized system like a can or soda or bottle of water. Pressure in one area affects the function of another area. So let’s take a moment to imagine what pregnancy, labor, and delivery can do to that system! A pelvic floor therapist can help bring back balance and coordination to that system so it functions as closely as possible prior to giving birth.
Your Body Post Pregnancy
The body changes a lot during pregnancy. The rib cage can expand, the diaphragm can be pushed up, the abdominals typically get stretched by the growing belly. In addition, the curve of the lower back increases as the person’s center of gravity gets shifted forward. As the uterus, that fun organ that grows and holds the baby, expands, that also creates downward pressure on the pelvis, pelvic organs, and pelvic floor. A person is able to deliver a baby vaginally and via cesarean section, and both delivery types come with their own postpartum challenges.
When a person comes to a pelvic floor therapist, that therapist is trained to know there are a lot of things that can happen during birth. First, they’ll want to know if the baby was born vaginally or via cesarean section. If born vaginally, was there any tearing or need for episiotomy (a cut in the perineum sometimes performed by a doctor)? If by c-section, how is the scar healing? How are the bladder and bowels functioning after delivery? Are you leaking urine when you laugh, cough, or lift your baby? Do you have pain when you are sitting or getting in and out of your car? Have you returned to intimacy with your partner, or are the feelings of your nether regions making you avoid sex like the plague? Regardless of birth experience, there are areas to be rehabilitated postpartum, and someone should be asking AND addressing these issues in a prompt manner.
It is a bizarre expectation of our society and medical system for people to bounce back from childbirth without any help. This literally happens nowhere else. Sprain your ankle, at least get a brace and some traditional rest, ice, and elevation advice. Have a knee replacement and you’re entitled to 4 – 6 weeks of therapy, multiple days a week. Get COVID and you might be given 1 – 3 months of time to recover based on the severity. Grow and birth a human (possibly having surgery to remove them and possibly being the primary food source for that offspring WHILE healing), and you should just return to your normal self. all. on. your. own. Again, it makes no sense to me.
Why Should You See a Pelvic Health Therapist While Pregnant or Postpartum?
So back to the original question, why should you see a pelvic floor therapist? Just for f*c&s sake if you have been pregnant at any point in your life. But if you’re still looking for reasons, I’ll give some examples below.
- You pee yourself every time you laugh, cough, sneeze, or yell. (COMMON, BUT NOT NORMAL!)
- Certain things trigger you to leak pee…running water, coming home, feeling cold, etc. (AGAIN, COMMON, BUT NOT NORMAL!)
- You avoid jumping jacks, running, or trampolines, because pee will leak if you do those things. (You should be able to do these things without leaking, even if you’ve birthed a child.)
- You do not poop soft smooshy bowel movements daily. (You should poop every day and it should be as easy to pass as soft serve ice cream.)
- You have vaginal or vulvar dryness. (There is help for this.)
- You have to RUN to the bathroom with the urge to poop. (No one wants to leak poop!)
- You think you have a diastasis recti. (There are so many questions about this, and a pelvic floor specialist is the perfect person to ask.)
- You have a clogged milk duct. (Oh yeah, we can fix the boobies, too!!!)
- You get up to go to the bathroom at night if you are under the age of 75 years old. (No one should be letting their bladder affect their sleep.)
- You pee more often than every 2 hours. (No one should be peeing every 30 – 60 minutes.)
- Your poop looks like rabbit pellets. (You are constipated, my friend, even if you poop that every day multiple times a day.)
- You have difficulty with orgasm…this can be new or a forever issue. (Orgasm should be an activity of daily living, and even if you have never reached it, you can do it!)
- You feel you can’t engage your core or have core weakness. (Pelvic health therapists are the best to engage these cores muscles in a functional way.)
- You have poop leaks or smears, or have to wipe FOREVER. (Let’s keep the poop in your butt until you are ready to put it in the toilet.)
- You can’t hold your pee if you get the urge to urinate. (You should have time to get to a toilet and go!)
- You have to strain to pee or poop. (Just say no!)
- You have pain with sex or any other form of intimacy. (Intimacy should never, ever, ever hurt, unless BDS&M is your thing.)
- You have any pain with any activity in your belly, back, hips, ribs, pelvis, etc. (No one should have to live in pain.)
- You’ve tried returning to your exercise and something does not feel right. (There are seriously therapists that specialize in your movement!)
What Can a Pelvic Floor PT Really Do For Me?
You may be thinking, “yeah, I have some of these things, but what can she really do for me?” It all starts with an assessment. I wrote a very detailed blog itemizing a pelvic floor evaluation and you can access it here. People always have a million questions, and I am always so happy to answer these for them. I totally understand that the idea of someone assessing your pelvis has the potential to sound terrifying. The short story is that we spend a lot of time talking about what is going on, what your history has been, and do an assessment of less intimate places like your back and belly. We then move on to education on what a pelvic floor muscle assessment looks like and if you’re OK with doing one.
Pelvic floor therapists have to do HOURS of training. Classes are formatted so therapists doing the training practice on each other, which means by “graduation,” a pelvic floor therapist has seen lots of perineums and knows what it is like to be assessed in this way. They are very well adept at doing an assessment and keeping awkwardness out of it. I swear to you, looking at a pelvic floor is like looking at an elbow for me at this point. It is a body part. Pelvic floor therapists typically do not use a speculum or stirrups, so there is a lot less scooting down and “you are going to feel a little bit of pressure” to look forward to.
Still on the Fence?
Let’s say you think you need pelvic floor therapy, BUT you really are not OK with someone doing a pelvic assessment of that area. That is alright. Please do not let that stop you. Pelvic floor therapists do prefer to assess and not guess, but we always value a patient’s comfort and safety above all other considerations. There are even some times that we do not do a pelvic floor assessment out of caution. This sometimes includes when a person is very newly pregnant, has some sort of pelvic rest order from a provider, if someone has an active infection, or if they recently had a pelvic procedure or surgery.
The awesome part about pelvic health therapists is that they are abdominal canister experts. That means they can often use external skills, other muscle areas, and movements to treat that do not require any internal interventions. Some clients also feel more comfortable with the idea of internal work with time and after building a relationship with their therapist. Either way, there are still things you can benefit from in pelvic floor therapy, even if you do not ever want internal work performed.
What will my therapist do after the assessment? TREATMENT! We have to help fix and retrain the things we found! Treatment varies because pelvic floor therapy is not one size fits all. So some people will need strength exercises, some will need stretches, some will need hands on work, and some people will need a combination of these skills. There are other tools in a pelvic floor therapist’s toolbox. These include things like education of all things pelvic health and some habits and lifestyle tricks that may help your pelvis health feel better.
More Frequently Asked Questions
Have I convinced you yet? Some other things people ask are:
Will my insurance cover this? It depends on the provider. Most insurance plans have some sort of PT coverage. Some providers are in-network, and some are out-of-network. When a provider is in-network, they take your insurance, and bill codes similar to what they would bill for therapy to your neck, back, or hip! If they are out-of-network, things can look a little different, but there are still ways to get services.
How often do I have to go? This depends on your provider, your schedule, and what is happening with your body and symptoms. I typically see patients 1x per week for an average of 6 – 8 visits, but this varies person to person. Some clients I see 2x per week at their request, and some I see once a month for check-ins, plan of care updates, and hands on work.
Will I have to do these exercises forever? The goal is no. Our plan is to build therapeutic exercises into your daily routine so that they are part of your functional life. This may look different for the person, but child care, gardening, and walking the dog might be part of your homework if those are regular activities for you.
Will this really help me? I have not yet filled a handful of clients who were unhappy about coming in for services. I cannot fix everyone, but just the education, knowledge, support, and education can be reassuring to clients. The people who left unhappy typically did not want to be an active participant in their care, and wanted a quick fix like a pill or surgery.
Next Steps
How do I get started? I take in-person clients in the South Jersey/Atlantic County area. I am able to do virtual treatments with people anywhere in New Jersey. I cannot treat clients out of state, but I can consult and provide wellness information for them. You can always reach out to me here to find out if working with me is something that will work for you. If I am too far, there are lots of other therapists with similar training to me that can be found here.
I hope this has helped you understand a little more about pelvic floor therapy so you can decide if it is something you need.
Practically Yours,
Dr. Mo
