FAQ: Pelvic Floor Physical Therapy
As moms, we’re all pretty familiar with the routine of visiting a gynocologist. It’s a necessary, but not very fun part of being an adult woman. Depending on your care provider during pregnancy, you also may have experienced cervical checks, various kinds of monitoring, and the obvious -- the act of giving birth, which is the exact opposite of modest. Basically: people be allllll up in your business, all the time. SO FUN.
So you may be uncomfortable with the suggestion that you add ANOTHER person to the list to check in on your lady parts, but trust me -- it’s important.
A visit to your local pelvic health physical therapist is a very important piece of your postpartum healing. In France it’s the standard of care. Have a baby, go directly to pelvic floor PT, do not pass go, and do not collect $200, but don’t worry about the $200 because it’s government-funded! That’s my dream for standard of care in this country, but I think we’re a ways away from that. In the meantime, you need to take responsibility for your own pelvic health and make an appointment. Why? A pelvic health physical therapist can help both treat and PREVENT (if you see them early enough!) the following conditions (not an exhaustive list; these are some of the biggies):
- Incontinence, both of the bladder and bowel variety
- Pain during sex
- Pelvic organ prolapse
- Pelvic pain, both during pregnancy and postpartum
But I had my six-week checkup after my baby was born, wouldn’t my doctor have told me about these things?
Maybe, maybe not. Your doctor is an excellent resource and you can absolutely discuss all of these issues with him or her. But some women don’t even get an internal exam at their six-week checkup, and even if they do, mild prolapses might be overlooked. Your doctor is probably not checking the tone of your pelvic floor, either -- something in which a pelvic floor physical therapist receives advanced, specific training. This is what they DO. They are the pros.
Ok, I’m convinced. How do I make an appointment?
Step 1 is to google “pelvic floor physical therapy” in your city, or “pelvic health physical therapy,” variations on that term. A regular physical therapist is NOT the same thing as a pelvic health physical therapist and they may or may not be able to help you.
Once you find someone, give them a call and ask whether your insurance is accepted and if you need a referral from your doctor before making an appointment. I didn’t need a referral from my doctor, but my physical therapist’s office does require one for treatment beyond 30 days. Your mileage may vary, so it’s an important question to ask.
You might be able to have a consultation with a physical therapist for free before you make an “official” appointment. Typically a consultation is only a conversation; no hands-on exams. But this can still be really, really helpful if you’re not sure what a pelvic health physical therapist can do to help you.
I made an appointment. Now what? I’m nervous!
Gold star for you! I’m proud of you for taking that first step. That’s the hardest part, honestly. Don’t be nervous. Your physical therapist is a professional and whatever your symptoms may be, they see them ALL THE TIME.
The next step, as with all things in the medical realm, is paperwork. Ugh. Boooooring but important, because they need to know about all your symptoms. Even the things that might feel just a little bit off, but it doesn’t really hurt, it just feels kind of achy sometimes and that’s normal, right? TELL THEM EVERYTHING.
And now the part that lead you to google “pelvic floor physical therapy what to expect”: the internal exam.
Yes, there is one.
No, it’s not any worse than a gyno exam. No stirrups or speculums involved WOOHOO!!!
Again, I am speaking from my own personal experience with physical therapy and your PT might do things a little differently, but my internal exam was conducted with only one finger and it was not painful.
Your PT will probably ask you to contract your pelvic floor muscles and see how long you can hold that contraction. They will check for any internal scar tissue, look for prolapses, test your pelvic floor strength on all four “walls” of your vagina from just beyond the vaginal opening to further up towards your cervix. That part of the exam is not exactly comfortable, I won’t lie, but it’s a necessary part of the diagnostic.
Once that’s done your PT will discuss everything that they’ve observed and felt, and start making a treatment plan with you. They’ll also teach you how to do a proper pelvic floor contraction (kegel, basically), and they can evaluate whether or not you’re doing it right (with, you guessed it, an internal check -- again, this stuff is so necessary for your proper pelvic health and function!).
I’m not going to go through the homework that my PT assigned me, because there are SO many variables with all this pelvic floor “stuff.” That’s the great part about going to see a pelvic health professional -- they will tailor the treatment to YOU, instead of you following a plan you found on the internet and not getting any feedback about what’s working and what’s not.
Your PT will also give you specific, just-for-you advice about what activities you can safely do right now and which ones to avoid for now. I, for instance, have a grade 2 prolapse. Running and lifting weights are off the table for me right now until I’ve sufficiently rehabbed my core and pelvic floor. I’m so bummed not to be running, guys, I can’t even tell you. But we’re taking the long view, remember?
I will set aside running and weightlifting for 6 or 8 weeks or longer, whatever my PT recommends, because...this is important...we don’t add strength to dysfunction. I know that running and lifting weights will make my prolapse worse and ain’t nobody got time for that.
We have to live the rest of our lives in this one body. Treat it well, ok?
If you’re in the Knoxville area, give Emily Pace at East TN Spine and Sport a call (Oak Ridge location). She's FANTASTIC and I pink puffy heart her. And to get some extra help with your core and pelvic floor AND strengthen the rest of your body at the same time, check out our group classes and personal training services!