Why Every Mom Should See a Pelvic Floor Specialist

With all the new tasks that motherhood includes, it can seem overwhelming to add another item to the to-do list. If there is one thing every mother should do after giving birth, it’s scheduling an evaluation with a pelvic floor specialist (PFPT). Are you experiencing a little leakage with sneezing or exercise? Have pressure down there after walking your baby or toward the end of the day? Is sex painful? Are you unsatisfied with how your abs feel and look? If so, keep reading to see how you will benefit from seeing a PFPT.

What the heck is a PFPT?

A pelvic floor specialist has a Doctorate in Physical Therapy with additional training and education in managing pelvic floor conditions. A PFPT has the ability to perform external and internal examinations and treatments to have a clear insight on the function of the pelvic floor, which is crucial for any mother recovering from pregnancy and delivery.

What is the pelvic floor?

I’m glad you asked. It’s a hammock-like set of muscles from the front of your pelvis to your tailbone. They aid in sphincteric control, lumbopelvic stability, organ support, and sexual performance. They control the 3 P’s: Pee, Poop, Procreation!

Pelvic Floor Dysfunction that the PFPT treats:

Incontinence: none is normal…running to the bathroom, leaking with sneezing, coughing, laughing, lifting, exercising

Diastasis Recti

Prolapse: Pressure “down there”

Pain with Sex or Insertion

Pelvic, Back, hip, sacrum or coccyx pain

Bowel Problems: constipation, leaking stool or gas, pain with BMs

What happens to the pelvic floor during pregnancy and delivery?

Throughout pregnancy, the weight of the growing uterus places pressure on the pelvic floor musculature and connective tissue while hormonal changes result in softening of pelvic tissues to prepare for delivery. Alone, these changes set up for a vulnerable pelvic floor.

During a vaginal delivery, the pelvic floor stretches almost 4x it’s resting length to allow for the exit of your beautiful baby. Often times the pelvic floor muscles tear and nerves are stretched, requiring an episiotomy and/or stitching.

In a C-section delivery, an incision is made through the abdominal wall and uterus, forming a scar as part of the healing process. Working with a PFPT after a C-section birth can help minimize adhesions that occur as scar tissue forms that can lead to pain, discomfort and urinary urge or incontinence.

It seems to be a no brainer that every new mother should be referred to a pelvic floor PT. When you tear any other muscle in the body, you are referred to physical therapy for the appropriate rehab and treatment plan. If you have a knee or shoulder surgery, you aren’t expected to go home for 6 weeks, then resume normal activities without professional guidance. Moms go through 9 months of physical changes while caring for a newborn. I’m here to break the stigma that women should be “normal” after a few weeks of giving birth.

A full body assessment with a PFPT empowers and educates women to learn about her body’s function, validates why she is experiencing pelvic floor dysfunction, and ensures that she can return to activities she loves.

What will an assessment look like?

  1. Full body screen- A thorough PFPT will not only look at the pelvis, but the entire body. Our bodies work as a unit. You experience so many changes to the joints, ligaments, muscles, nerves, etc throughout pregnancy and those structures don’t just “bounce back” despite what social media portrays. The hips and thorax will play a key role in how the pelvic floor is functioning and recovering postpartum.
  1. Abdominal Assessment- One common core dysfunction I see postpartum is Diastasis Recti (the separation of the connective tissue between the 6 pack abs). This can be 100% treated with the guidance from a PFPT. Your abdominals were stretched to capacity and they need to have coordination, strength, and endurance to do all of these new repetitive tasks such as carrying the carseat, picking up the baby, and prolonged nursing positions. The abdominals require specific guidance and individualized treatment depending on what you want to return to.
  1. Internal Pelvic Floor Exam- A PFPT will determine the strength, endurance, coordination, and tension of the pelvic floor muscles. This will allow the PT to determine if the mom should focus on strengthening, relaxing, or improving coordination of the pelvic floor.

Your 6-week check-up isn’t enough to give you the green light!

You will most likely have one check-in postpartum that will include a quick uterine check ensuring tissue healing from stitching, a mental health questionnaire, and the OK to return to whatever you want to. Although an internal exam is performed, the provider isn’t checking for pelvic floor muscle function, organ prolapse, nor diastasis recti. With women given the “green light” to resume exercise and sex, mothers may jump back into exercise their bodies aren’t prepared to manage, leading to potential greater risk of injury or worsening of symptoms. Don’t settle for “Oh that’s normal”, or “Just do kegels” or “Just give it time”. You deserve more! You deserve to have a thorough assessment and an individualized plan of care to get you back to where you want to be.

Postpartum Recovery is More than kegels

This is the most common recommendation from providers and what you will most likely see with a quick google search for safe exercises postpartum. While kegels (pelvic floor contractions) can be a helpful tool, they are never the end-all-be-all when it comes down to a functioning pelvic floor. In a lot of women, their pelvic floor muscles are over-recruited or hypertonic, meaning the pelvic floor is spending it’s time in a Kegel unknowingly. A functional pelvic floor should be able to move throughout its entire range of motion and also know how to stretch and lengthen, just like every other muscle. Despite social taboos, a “tight” pelvic floor is not a functional pelvic floor and can cause pain with sex, stress incontinence (leakage with sneezing, exercising), the sensation of heaviness or pressure, or the inability to feel the pelvic floor contract leading a women to believe her pelvic floor is weak and therefore beginning a regimen of kegels, not knowing it is exacerbating her symptoms.

A well-functioning pelvic floor is crucial to performance in fitness and everyday tasks

The pelvic floor is a stabilizer from the inside out. Whether you’re lifting a car seat, your baby, or a barbell at the gym, the pelvic floor responds to stabilize and provide support. Without proper rehab postpartum the body will be susceptible to injury and pain. Many new moms return to fitness too soon after that 6 week mark to “bounce back” but end up leaking or experiencing pressure and pain.

How long after giving birth is it too late to see a PFPT?

It is NEVER too late! If you see a pelvic floor specialist postpartum, you are ahead of the game. Even if you are scanning through the most common pelvic floor dysfunctions and saying to yourself “I don’t have any of this”, still get an assessment. Just because you don’t have symptoms now, doesn’t mean you won’t have them later. Being proactive is crucial for developing an appreciation for your body.

Can you see a PT during pregnancy?

You should see a PT throughout your pregnancy. It’s so important to learn how to recruit the pelvic floor muscles, what to expect of the pelvic floor muscles throughout labor and delivery, and how to manage the pelvic floor postpartum. PFPT during pregnancy can teach you labor/delivery positions, how to breathe while pushing, pain management strategies and most importantly empowerment! All of this is aimed to reduce tearing of the pelvic floor muscles during delivery, to lower chances for pelvic floor dysfunction postpartum, and to give Mom a voice.

How can you find a pelvic floor PT in your area?

I’m in the Tampa Bay region and serve local women and men by treating them at their house, work space or in the clinic. I also provide virtual assessments for those that are not local to the Tampa Bay region.

To schedule a free 20 minute call to see if you would benefit from pelvic floor therapy click https://femmempower.as.me/drandreafree

There is a pelvic floor directory located at www.apta.org or pelvicguru.com

By: Dr. Andrea Yarbrough, PT, DPT