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What is the pelvic floor?
The pelvic floor is a group of muscles that line the bowl of the pelvis and assist in bowel/bladder control, sexual function, supporting the pelvic organs, and stabilizing the pelvis and lumbar spine. It is one of the key muscle groups that works as our “core”. These muscles also help with sphincteric control and sexual function. When these muscles are weak there are a multitude of symptoms that may arise including urinary or fecal incontinence (involuntary leakage), involuntary passing of gas, or contribute to low back or pelvic girdle pain.

When the muscles are tight, a person may experience pain within the pelvis, difficulty emptying either the bowels and/or bladder, pain or inability to tolerate intercourse, marked pain during gynecological exam, abdominal pain and more. During pregnancy, as with many other areas, there are numerous changes that may occur. Combined with the stress these muscles undergo during delivery – even with cesarean sections – it is inevitable for the muscles to need a little TLC afterwards.

What is pelvic health physical therapy?
Pelvic health physical therapy focuses on musculoskeletal dysfunctions within the pelvis, hips, abdomen and the adjacent joints. Treatment may also include working to restore posture, general strengthening of core and hips, relaxation and down-training techniques, manual therapies to the external and internal muscles including myofascial release, scar tissue mobilization, visceral mobilization and much more.

The goal of pelvic physical therapy is to restore the length, function and activation of these muscles in a more optimal fashion. This will allow for more unrestricted participation in all of life’s activities – including jumping on trampolines.

What to expect for the first visit?
For the first visit we will review your general medical history, birth history, bowel, bladder and sexual function, orthopedic issues, etc…anything that could influence your function and return to activities. Following this, we will complete a physical exam, both of the orthopedic and pelvic floor muscles.

To adequately assess the pelvic floor muscles, a brief internal assessment is performed to determine if these muscles are tight and/or weak. The physical exam helps us adequately identify contributing factors to your symptoms and from here we develop your personalized treatment plan. An internal assessment is not necessary at every treatment. Most often there may be 1-2 assessments needed, depending on what the primary problem is and how well someone can contract the muscles.

A treatment table, sheets, and all other treatment equipment is brought to your house by the therapist. All you need to provide is yourself and maybe a pillow to rest your head on during the exam. Each following visit varies depending on the findings from the initial exam but commonly contains a variation of stretches, strengthening exercises and loads of information!

If a patient is experiencing vaginal, rectal or lower abdominal (bladder) pain, routine internal assessments are the most effective method for treatment. However, even diagnoses that are in large part involving the internal muscles benefit from working on external structures such as the thighs, abdomen, glutes or back.

How often do I need therapy?
Most patients do well with just one visit every 1-2 weeks for a few weeks then are able to decrease to every few weeks as they feel better and are more proficient with the exercises. This allows you enough time to work through the exercises and practice new strategies we’ve discussed and be ready for the next progression of exercises.

If you are experiencing significant orthopedic aches and pains, it can be worthwhile to be seen two times per week until we get things better managed. As you get better, we schedule you less frequently until you feel you have all the tools you need to succeed and are feeling better overall.

I've done Kegels before and they never worked for me.
Patients will frequently report that they have done Kegels in the past and they haven’t worked for them. In truth, a vast majority of patients that report having done Kegels and note they haven’t worked were either doing Kegels incorrectly so not getting the full benefits of their work or they weren’t doing nearly enough of them. Current research is suggesting 90 Kegels a day in order to make good measurable strength gains over the course of a 6-8 week period. There are also several other factors to consider such as managing intra-abdominal pressure, posture, general strength, breath pattern and more.

NOTE: The common misconception that pelvic physical therapy is only about Kegel exercises is untrue. Although exercising the pelvic floor muscles is important, there is much more to optimizing function. Finally, it is important to be assessed by a therapist to determine if Kegels are appropriate for you as someone who is experiencing pain or has muscles that are already tight, strengthening these muscles may be counterproductive and cause more problems.

Benefits of therapy after delivery.
So you conquered both pregnancy and delivery! High five girlfriend! Regardless of how the delivery proceeded, there is work to be done. Wouldn’t it be nice to say that after delivery and a good 4-6 weeks of recovery and our bodies bounced back to normal? Unfortunately, the truth is there is a “new normal.” It takes time for the muscles of the entire body to come back to their new normal resting position. Many women can return to physical activity without issues, but the orthopedic issues that may have occurred during pregnancy do not always resolve after delivery. Sometimes women have more aches after delivering than they did during pregnancy from the new stress of carrying and feeding the baby. Often, some gentle stretches and exercises can resolve a majority of the discomfort.

For the vast majority of women, if they don’t retrain those muscles to functioning in the proper alignment and positions again there can be lasting implications. Worse yet, symptoms may only begin to arise much later in life. The truth is, that if we don’t focus on the correct recruitment and activation pattern we will continue to reinforce the dysfunctional movement and stability patterns that are developed through the slow 9-month progression of postural changes called pregnancy.

Even women who are not experiencing symptoms benefit from participating in a couple sessions of pelvic health physical therapy. Countries who offer pelvic health services as a standard of practice to postpartum women have a decreased rate of incontinence, prolapse and many other pelvic floor issues throughout the lifespan. Just as other muscles need to be exercised routinely to maintain wellness, the muscles of the pelvic floor need to be exercised consistently as well. As we age, our muscle fibers decrease in quality as well as quantity. You may not have any symptoms at the moment, but as the muscles age symptoms can then begin to appear.

The strain of pregnancy and delivery is followed by sleepless nights feeding and/or nursing the newborn in poor postures and adding stress to the shoulders, neck, back, etc. Pelvic health therapy after pregnancy isn’t just for the pelvis. It’s for the whole body and about restoring the alignment and efficient movements of each woman so they can return to their normal activities.

But what if I "only" had a cesarean section?
For women who go on to have a cesarean, your pelvic floor muscles are still affected by the pregnancy. In general, the muscles are under greater stresses and have to support more weight from the baby and uterus during the nine months. Posture is greatly changed through pregnancy and your recruitment pattern is altered by this change.

Unfortunately, our bodies don’t just bounce back to their normal function. We must relearn and retrain the muscles to function properly again. Without coordinated training, you will continue to move within the abnormal strategy. Additionally, your abdominal wall was cut through which can greatly impact the strength and recruitment of these muscles.

Is it normal to have leakage after having kids?
It is quite common for women to experience urinary leakage after delivery. It often will improve over time, but not fully resolve. In fact, one in three women will experience urinary leakage at some point in their life even without having had kids. It has become a stigma of our society that it is normal to leak after having kids.

This is especially true with jumping, coughing, sneezing, etc. However, this is a large misconception. It is very common for this to occur, but it is not normal. Nor is it normal to leak gas. Pelvic health physical therapy helps to strengthen and address any other contributing factors to assist with improving the control to sphincters of the bowel and bladder.

What other diagnoses can pelvic health physical therapy address?

As you can tell, there is an array of symptoms that may occur and that pelvic health therapy can address including, but not limited to, the following:

  • Coccyx pain

  • Constipation

  • Diastasis Recti Abdominis

  • General weakness following pregnancy

  • Hip, low back, shoulder pain and/or headaches

  • Irritable Bowel Syndrome

  • Nursing considerations

  • Painful intercourse

  • Pelvic Organ Prolapse

  • Urinary / Fecal Incontinence

  • Urinary Urgency / Frequency

  • Vaginal pain or tightness

When is it appropriate to start pelvic physical therapy after delivering?
Whenever you are ready! For orthopedic issues, if there is something that is bothering you and impacting your ability to comfortably navigate through your new routine with your baby, it can be helpful to start sooner and resolve any of those limitations, so you can focus your attention on more important things.

For internal pelvic floor assessment and treatment, it is best to wait until your six-week check up to get the all clear from your provider that things have healed well. Prior to that six-week checkup, we can discuss several strategies and techniques to optimize healing and improving bowel or bladder function that are commonly affected after delivery.

What if I'm menstruating?
It truly does not make a difference. We typically tell women that as long as they’re comfortable with internal work, we can continue with that. However, there can also be a lot to treat externally (working on the abdomen, exercises, soft tissue work, etc) that can be done to keep you on track with your goals. Additionally, there can be relief from symptoms like cramping, back pain and other menstrual based symptoms. So there’s no need to reschedule your appointment.
Do you take insurance?
We are now contracted with a couple insurance companies. Please reach out to us directly so we can check to confirm whether or not we are contracted with your carrier.

Regardless of your network status, we will check your benefits so you are aware of what your cost estimate will be. For out of network plans, this means that we will do our best to determine your potential for reimbursement. Any reimbursement from insurance would be made directly to you by your insurance company. We are happy to also assist you in completing the necessary forms to receive reimbursement at no additional charge.

For all appointments, payment is due at the time of service.