physical therapist stretching patient's hip during pelvic floor therapy work

Pelvic Floor Physical Therapy

What is it and why do I need it?

Thirty-three percent of new mamas report bowel and bladder issues after birthing, and this percentage grows when a mama is over 35 years old. At their six week visits, many are told this is “normal” for having given birth. Unfortunately, the symptoms of pelvic organ dysfunction are not normal, but they are common. These issues don’t go away without some attention and shouldn’t be ignored. There is no “quick fix” by taking medications or having surgery. They require manual work by a skilled pelvic floor physical therapist, compliance to a home exercise program and often times some tweaks in lifestyle.

Pelvic Floor Physical Therapy (PT) is the use of hands-on PT to stretch, strengthen and relax muscles in the pelvic bowl (your pelvic floor). It is a specialized type of PT that treats bowel, bladder and sexual dysfunction through the musculoskeletal and neuromuscular system. Simply put, there is a “pelvic bowl” of muscles that hold up your pelvic organs: Your bladder, rectum and uterus. If something goes wrong with these muscles or their associated nerves, things can go askew. Tightness, weakness, spasm, scarring—all make it difficult for our pelvic bowls to do their proper jobs.

The goal of a physical therapist is to help you recover your health and function. This is done through an understanding of the physiology of birth, the postpartum body, and the woman’s pelvic organs, combined with manual manipulation to work on the muscles and tissues that need help. The right physical therapist also help you through education, empowerment, and working together as a team to resolve whatever difficulties you’re having.

In many countries, after a birth, pelvic floor PT is a regular part of a woman’s postpartum care. While in the United States this is still not common practice, more and more it is being recognized as a vital part of the postpartum healing process. Women who experience prolonged pushing phases, perineal tears greater than stage 2, or women post c-section will often be referred to pelvic floor PT by their obstetricians or midwives. Many women receive the “go ahead” for return to pre-birth activities at their six week visit. While this is usually a safe time to return to sexual intimacy, often times, this is still too soon to return to running, high-impact exercise, or prolonged endurance activities.

The pelvic floor is comprised of many ligaments that help to suspend your organs. These ligaments will still be stretched out and weakened from months of pregnancy, the weight of the uterus/baby/fluids, and the added hormone, relaxin—which remains in our bodies until after we finish breastfeeding. It is best to return to exercise slowly, increase intensity gradually, and use the guidance of a pelvic floor PT to determine how much is too much or too little. Often, prior to receiving care, many women undergo months of embarrassment, changes in lifestyle to reduce fluid intake or exercise due to bowel/bladder incontinence, strained relationships with partners due to painful intercourse or poor function.

PT is about much more than improving the functions of your pelvic organs and muscles, it is about giving you the tools to restore your confidence and reclaim your life.

Close-up of physical therapist stretching patient's hip during pelvic floor therapy work
Manual work is a big part of pelvic floor physical therapy.

Common Questions

As a pelvic floor and postpartum physical therapist through Sage Birth and Wellness Collective, I often hear some common questions regarding starting pelvic floor physical therapy, such as:

What do I bring?

Bring a list of your medications, as well as adjunctive treatments. Much of the evaluation is a collection of subjective information in the form of questions. Many of these cover personal topics and may feel difficult to discuss openly. I maintain strict confidentiality, and I can help you more thoroughly if I understand your problems in their entirety. Please also wear clothing that you might wear to a yoga or pilates class.

What can I expect on the first treatment?

After receiving your history, I’ll assess your body’s posture and musculoskeletal system. I look at form and function—the joint mobility or lack thereof, strength, endurance, imbalances, and anything else that may be contributing to your problems. Then, with your permission, I’ll conduct an external and internal pelvic floor muscle exam to check your pelvic bowl and determine what may be contributing to the issues you’re dealing with. I will be in constant communication and will explain every part of the exam. If you experience any pain I will stop immediately. My hope is that you feel as safe and comfortable as possible throughout evaluation and treatment, and to establish a treatment plan that works for you moving forward.

If I’m pregnant can I receive pelvic floor PT?

While I don’t do internal work with women while pregnant, YES!! Low back, round ligament pain, sacral misalignment or SI joint disfunction are all common conditions affecting pregnant women. We can get much done externally, including work on posture, core strength, and may discuss ways that your upcoming labor can be made easier, more efficient and more comfortable for your body.

How many visits will I need?

This depends! Each body presents and heals differently. If you’re eager to return to running or high-impact physical activity, and are leaking every time you jog around the block, it may take several weeks or months to get back up to speed. For women who had complex issues prior to pregnancy and delivery compounded the problems, it can take longer. For women who don’t require extensive pelvic work but only are dealing with back or neck pain after baby, it can take only a few sessions. Mostly, it is often determined by your willingness to participate in a home program and do self-care. Visits usually occur once weekly or bi-weekly but recovery depends on a strong commitment from you to get the results you desire!

Photography by Sarah Boccolucci Photography

PT, CD(DONA), Physical Therapist at Sage Birth and Wellness Collective