• Emily Holyoak

Why Should I See a Pelvic Floor Physical Therapist?


Pregnancy and birth are things that change a woman’s body forever. Some of the changes might be temporary and fairly small, but some have the potential to affect our health for the rest of our lives.


One area that is critical to our health is the pelvic floor. The pelvic floor is just that; the skin, muscles, nerves, and tissue that span beneath your pelvis and between your legs. It’s a bit like a supportive net of muscles. This network provides support for your digestive system, reproductive system, organs, and movement. Basically, the pelvic floor keeps all of your insides from falling out!


In addition, a healthy pelvic floor can help you have more bladder and bowel control throughout your life. That means that peeing when we laugh, sneeze, or run won’t happen anymore! It also gives us a reduced risk of prolapse (organs sliding out of the body), and generally increases our quality of life by improving our movement, sex, urination, digestion, and overall peace of mind.


It’s a big job for one area of the body, but I never gave much thought to the pelvic floor, or really even knew it had a name, until I was dealing with the effects of pregnancy and birth.


Pelvic Floor Disorders


People can develop pelvic floor disorders for a variety of reasons, including chronic coughing, heavy lifting, strain on the toilet, or just natural aging.


However, pelvic floor disorders are extremely common during pregnancy, birth, and postpartum, making this a very important topic for mothers. According to this study, about 25% of U.S women experience pelvic floor disorders at some point in their lives. So even if you don’t have a serious problem with this, the chances are good that someone you know will! It also doesn’t hurt to learn a bit of self care for the pelvic floor to help us know what is and isn’t normal.


During pregnancy and birth, a lot of strain is put on the pelvic floor. Our organs are shifting and rearranging, not to mention compensating for the growing size and weight of a new baby! During pregnancy, you probably had to pee more often, or noticed that your hips were sore. This is all due to increased pressure on the pelvic floor.


Once we’ve given birth, things only get even rougher down there. Birth involves a lot of pushing, straining, and physical trauma. Even the healthiest births will stretch our pelvic floor beyond its usual limits, and mothers who have given birth multiple times, have especially large babies, or experience perineal tearing, are at much greater risk for developing pelvic floor disorders.


The postpartum period is a time for us to adjust to our new lives as mothers and to heal from the stresses and injuries from birth. A certain amount of soreness and postpartum bleeding is to be expected during this time. Sometimes, however, pelvic floor issues become manifest during postpartum.


If the initial healing period of six weeks is over and you’re experiencing any of the following symptoms, a visit to a pelvic floor physical therapist might be in order.


  • Uncomfortable or painful sex

  • Involuntary leaking of urine of feces

  • A feeling of immediate urgency every time you need to use the bathroom

  • A noticeable delay before urine begins to flow

  • A general feeling of achiness or pain in the pelvic area

  • Muscle spasms or cramping in the vaginal area

  • Dryness/irritability of the vagina

  • A feeling of heaviness in your abdomen

  • Overly loose or tight muscles in the pelvic floor

  • Purple or dark colored labia

  • Constipation

  • Feeling like your organs are falling out of your vagina or anus

  • Lower back pain


It’s important to listen to our bodies during this period. Don’t let people tell you that these things are normal and that this pain and discomfort is nothing to worry about. Just because these things are common doesn't mean they’re normal. If someone tells you that any of the above symptoms are just inevitable parts of motherhood, don’t listen to them.


Our health and happiness matters as mothers, and the pelvic floor is a gateway to helping us feel so much better. This is a good time to consider visiting a pelvic floor physical therapist for an examination and possible treatment.


What to Expect from a Pelvic Floor Physical Therapist

When we’re dealing with pain and problems with the pelvic floor, it might feel uncomfortable to seek help with it. When I was experiencing pains in my pelvic floor, I wanted to stay away from doctors because I felt like I could deal with the pain myself and it would go away in time. I also didn’t know what was normal and abnormal down there postpartum, since it was my first baby.


The truth of the matter is, pelvic floor disorders sometimes (and often don’t) resolve by themselves. When I was having good days, it was easy to convince myself that I was fine and didn’t really need clinical help. But since the bad days kept popping up again and again, it was time to consider a visit to a physical therapist.


It’s important to feel heard and supported when it comes to pelvic floor issues. When someone breaks their arm, they wear a cast. This is a signal to people around them that they might be in pain and need some extra patience and help. The same thing is true of many injuries and disorders, but pelvic floor disorders are basically invisible to outsiders.


Because we can’t see them in other people, it’s easy to assume that pelvic floor disorders are nothing to worry about - or that they’re normal. I met a woman who had been peeing her pants for 8 years after having a baby because she thought it was normal postpartum. It’s not normal, and there is a way to fix it.


It’s hard to be feeling a lot of pain or discomfort when nobody can see why and offer their assistance. This is why the rise of pelvic floor physical therapy is so amazing!


So, what exactly do pelvic floor physical therapists do?


Just like any other physical therapist, those who specialize in the pelvic floor want to improve the area’s function, increase your health, and generally create a stronger, more resilient body. Pelvic floor specialists improve the structure’s alignment, strengthen the supporting muscles, and find ways to reduce pain.


Many of these therapists are willing to schedule virtual meetings or phone interviews before you go into their office. These meetings can help ease us into the world of pelvic floor physical therapy and also give the doctors an idea of what we might be dealing with.


When you go in for physical pelvic floor examinations, the therapist will need to insert a gloved hand or finger into your vagina to feel the position, strength, and irritability of your pelvic floor muscles. Since these are not externally visible parts, this type of examination is necessary.


This process will show the therapist which areas are out of alignment, which are painful, and will help them know the best course of action to help you. With the help of exams like this, they can also find out if there are areas that have been torn or infected, which might not be obvious upon first glance.


If you have any scar tissue from birth or have experienced any trauma in your life (regardless of whether or not it was sexual in nature), you may cry or have some other kind of emotional release during an exam or therapy while the physical therapist’s finger is in the vagina. We store a lot of emotions in our pelvic region, and especially in scar tissue. If you cry or have big feelings come up during an exam, just know that it’s okay.


I recommend talking to someone you trust about these big feelings, especially a therapist that regularly works with trauma or psychosomatic psychology.


Beyond the physical exams, a pelvic floor therapist will probably have a one-on-one discussion with us about our health and any problems or concerns we might have. It’s important to be as thorough as possible during these meetings so that we give them the best information to work with. Sometimes even things that seem unrelated, like falls or a flat foot can lead to discomfort in the pelvic floor!


Once they get a good idea about our situation and pelvic floor health, they’ll be able to recommend treatments. These might include things like scar tissue massages, medication, kegels, or surgery.

Although the pelvic floor and the physical therapy that specializes in that region can seem scary and unfamiliar, so many of the practitioners know what we’re going through and will completely understand what we need.


Sara Reardon is a great example of this! She’s a pelvic floor physical therapist who has made a career out of removing the stigma around the vagina and pelvic floor. She has an amazing and insightful social media presence and you can check out her website or visit the.vagina.whisperer on Instagram.


The Role of Kegels in Pelvic Floor Health

Pelvic floor exercises (also known as kegels) are a series of contractions and relaxations of the pelvic floor muscles. Depending on what your physical therapist recommends, these might be a good idea to implement into your pregnancy and postpartum self care routine.


Please make sure that you’re doing the correct exercises for your situation. Pushing ourselves too hard or focusing on the wrong muscle groups can end up hurting more than helping. Sometimes the problem is that the pelvic floor muscles are too tight, so flexing them a lot might actually make your injury worse.


Kegels are designed to strengthen and heal the pelvic floor, so if we discover ourselves feeling too tight, too loose, or in a lot of pain, we might need to consult with our physical therapist again for a new program. Doing the incorrect kegels for our situation can cause more harm than good.


If you’re experiencing discomfort, pain, or you feel like something’s just “not right” down there, know that there is hope and you can get help. A pelvic floor physical therapist can help with diastasis recti, constipation, and so many other things - plus they can improve your quality of life.


Thank goodness for pelvic floor physical therapists!

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