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The answer to Should I See A Pelvic Floor Specialist and other questions relating to what the pelvic floor is, signs of damage, whether new moms should see one during pregnancy or after delivery and more!

Hi friends!

Should I see a pelvic floor specialist? That’s a question I found myself asking a few months ago so we’re taking a break from food today to talk about the pelvic floor. A couple of months ago I mentioned that I went to see a pelvic floor therapist for the first time after having baby 3. It’s something I should have done after each kid but if you want the truth, 4 years ago I had never even heard of a pelvic floor. Enter Instagram and a huge rise in the number of people talking about it, which left me wondering- should I see a pelvic floor specialist?

After a little research, I decided I should. I met with a PFPT, who did an internal exam, asked lots of questions etc, determined I didn’t have any major issues. I went on my way and kind of forgot about it. A few weeks later, I was having intense hip pain. I’ve always struggled with hip pain and have actually been seeing a muscle activation specialist for about 2 years now. They’ve gotten a lot better but after baby, they were pretty much back where they started. We determined that the problem could actually be stemming from my pelvic floor. Mind blown.

When I mentioned this on my IG stories, I got a huge number of questions about the pelvic floor and it is clearly not my area of expertise. But i think this is a super important topic, especially for moms, so I knew I wanted to help educate. I reached out to 3 physical therapists who specialize in pelvic floor/women’s health and asked them to answer some of the questions my followers had! And then I compiled them all into a blog post for easy reference!

Huge thanks to these ladies for their expertise:

Krystle Howard, PT, DPT of Expecting and Empowered
Jessica Valent, PT of Jessica Valent Pilates
Allison Bell, PT, DPT

Ready to learn? Here we go!

What is the pelvic floor and how does it work?

The “pelvic floor” is a group of muscles that are housed inside your pelvis. It forms a basin-like structure that spans from your tailbone to your pubic bone. Together they form a sling of muscles that provide support and help stabilize EVERYTHING above, including your bladder, uterus, rectum/bowels & all your abdominal cavity contents. The muscles themselves work like any other skeletal muscle in the body (think biceps) they contract to help hold in urine/stool/gas and relax to help empty bladder/bowel. They are also a critical player in “core stability” so they help to stabilize our body against outside forces. The pelvic floor should work on its own without a lot of help from us, but in many cases, trauma or injury can occur which means we need to help re-educate and train the muscles again!

Should you see a pelvic floor therapist while pregnant or after delivery? How long after delivery should you wait before seeing one?

During pregnancy, you should definitely see a PFPT (pelvic floor physical therapist) if you’re having pain or significant incontinence. Internal work is only recommended in certain cases during pregnancy because it could disrupt the membranes and potentially cause contractions. However, external work can definitely be done during pregnancy and some PFPTs may specialize in pregnant patients and could help you prepare for delivery by training your pelvic floor and hip muscles, practicing positions, pushing techniques, etc.

After baby 100% YES! EVERY woman should see a PFPT after delivering children, regardless of how “easy” delivery was. If only to learn how to recruit their pelvic floor & that they are “okay”. Delivering a baby IS a major trauma to your body so proper recovery is necessary. A pelvic floor PT can re-teach you how to properly use your muscles after delivery.

It’s best to be cleared from your OB prior to PT postpartum, they will likely (& should) do an internal assessment to determine the health of your pelvic floor and most want you to be cleared first.

An additional factor to consider is your insurance… some only give 60 CONSECUTIVE days of therapy PER calendar year, so if that’s the case, waiting until you’re postpartum may be the better option.

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

It’s never too late!!! Early intervention is always best but it’s NEVER EVER TOO LATE! Anyone having incontinence, pain with sex or pelvic pain, even ten years after giving birth, could benefit from the proper training. Both a Women’s health PT and an orthopedic PT are great options because an orthopedic PT can also help with other postpartum problems such as back pain, carpal tunnel, and other problems related to being a mom.

Should only moms see pelvic floor therapists? If not, who else might benefit?

Everyone has a pelvic floor & pelvic floor dysfunction is NOT isolated to pregnancy & postpartum. Or even just women. Men have a pelvic floor and can have problems as well and there is also a need in the transgender community as transitional surgeries become more common. You should see a PFPT if you experience urine leakage, pain with intercourse, pain with tampon insertion, endometriosis, pain in your pelvis…), have bowel troubles (both constipation and bowel leakage) or anything else that doesn’t “seem right”. This could be heaviness or pressure that’s new or changing.

PFPTs are seeing more and more women in their 60’s and 70’s who benefit tremendously from pelvic floor PT. As our estrogen decreases with age, our muscle elasticity also decreases. That means the musculature in our vaginal wall and pelvic floor loosens. Prolapse becomes very common as well as incontinence.

How can you find a pelvic floor therapist in your area? What should their title be? What degrees/certifications should they have?

This can be the hardest part!!! Finding a good PFPT is tough, the field is still small. Start by asking around. Ask your OB, your primary care doctor, friends or other health care professionals you know (chiropractor, PT, OT, acupuncture, etc). Look online by searching “women’s health PT” or “pelvic floor PT” in your area or go to www.apta.org, click search for a PT and choose the Women’s health category.

Their title will likely just be Physical Therapist but they should specialize in “women’s health” or “pelvic health”, they should have continuing education courses which have trained them in treating the pelvic patient.Degrees necessary are at minimum a masters or doctorate in physical therapy (DPT or MSPT).

More than anything you want someone you have a personal rapport with and who you trust. This can be a frustrating and scary and confusing time and it obviously involves a personal part of your body. If you meet someone and you don’t feel listened to or cared for or you don’t see a clear plan in place, find someone else. Keep searching and advocating for yourself until you get the care you need.

Is it really necessary for all moms to see one?

Likely, yes. If you had major knee surgery, you wouldn’t expect to just go home, rest for 6 weeks and then resume normal activities on your own. You’d expect surgery, healing and then rehab. Pregnancy is a traumatic event that happens to our body. We go through 9 months of physical changes, then months of hormonal changes while caring for a newborn. We need to change the stigma that women should be “normal” after a few weeks giving birth.

This doesn’t mean every woman will have pelvic floor problems postpartum but many do. And even more can have problems develop months or years after giving birth. That means you can feel great after birth, start running right away and being hard on your body, and not know you are causing damage. It would be great for everyone to know how to protect their bodies for the long term. Pelvic floor PT isn’t a bad thing. It can be extremely beneficial and can open your eyes to things you didn’t think we wrong & should be normalized. In many European countries (Sweden, Norway, France, Germany) its standard practice for women to be AUTOMATICALLY sent to PT postpartum regardless of birth event or symptoms. Preventative Rehabilitation is key for long term health & wellness.

The problem with moms though is that they will fall off the bandwagon, meaning that they’ll come in for one or two sessions (when really they need 6) until its partially better and then their follow through is poor. Resources like the Expecting & Empowered Guides are meant to “pre-hab” these injuries before they happen, if they happen, and after they happen. The strength training is specific to moms and can help provide a long term fix.

How would you even know you have an issue/What sort of issues could your pelvic floor be causing?

pain: in pelvic floor, with intercourse, during menstruation, with tampon insertion…
Pressure “down there”
Urinary incontinence: none is normal… running to the bathroom, leaking when coughing/sneezing/laughing/lifting/exercising, waking at night to go to the bathroom
Bowel problems: constipation, pain with bowel movements, leaking stool…
Diastasis recti
Back pain
Prolapse

Your pelvic floor could be leading to many problems, for example, it could even lead to a foot problem because if your pelvis can’t stabilize, then you have SI and pubic symphysis problems, thus leading to foot pain. The pelvic floor in an essential part of making things automated in your body.

What exercises can be done during pregnancy to help prevent problems?

While pregnant it’s important to learn how to recruit and use your pelvic floor muscles. You should also learn how to manage pressure systems (breath, core, pelvic floor) by working on diaphragmatic breathing and activation of the deep core muscles (TA). . It can be beneficial to avoid certain exercises like planks, jumping, lunging, twisting etc when you reach a certain point in pregnancy and not return to them too quickly postpartum.

Sometimes problems can’t be avoided. They can often be caused by long labors, long pushing and the use of vacuums and forceps. Anyone who has experienced those would benefit from pelvic floor PT.

What are the best at home exercises to strengthen the pelvic floor and how often to do them?

There is no specific exercise that is best for your pelvic floor. The best is a combination of exercises that changes the angle that the pelvic floor is at. The best thing to do is to start BREATHING PROPERLY and then start turning on your pelvic floor as you do things so that you can begin to automate this system. ex. Kegel in quadruped

Expecting and Empowered has fitness guides for each trimester of pregnancy (which also teach diaphragmatic breathing) as well as a postpartum guide. You can find some pelvic floor exercises in this video from Jessica. You can also check out this course from Julie Wiebe, PT which is a series of videos which are written for the female and can teach you how to find your pelvic floor & how to recruit it with your breath.

Hope this was helpful! There is obviously so much more information about the pelvic floor out there and lots more to learn. I encourage everyone (especially moms) to consult with a pelvic floor PT if you haven’t already! Here are a few more people to follow on Instagram for more pelvic floor info: