Throughout my experience as a pelvic floor physical therapist I have heard many misconceptions from clients regarding pelvic PT. In this blog, I would like to provide more information to help clear up some of the most common myths out there about pelvic floor PT.
Myth #1: Pelvic floor PT is the same as “doing your Kegels”.
This is a myth that is quite widespread and I hear it from both providers and clients alike! Although knowledge of pelvic floor PT as an option for addressing women’s pelvic floor issues is severely lacking in the general public, most women I work with have heard of Kegels. Many of my clients regretfully inform me that they wish they had listened to their medical provider and “done their Kegels” after childbirth to help their pelvic floor recover. Even more women tell me at their first visit that they have started “doing their Kegels” but a) aren’t sure if they’re doing them correctly, and b) do them halfheartedly when they think of it because they weren’t informed of how many to do or how often to do them.
A quality pelvic floor physical therapist will address SO MUCH MORE than Kegels. We perform a completely different type of internal exam than you may be used to at the gynecologist. We are spending time thoroughly evaluating the tone, strength, endurance, speed and coordination of multiple layers of pelvic floor muscles and empower you with information about your body. We perform a holistic assessment including the relationship between your pelvic floor muscles and the bigger picture of your movement strategies/patterns, your posture, your alignment, and how it is all influenced by the context of your life as a person. And yes, we will also let you know if you’re doing a Kegel correctly and if you should be doing them at all. And if they happen to be part of your exercise program, you bet we’ll prescribe reps, sets, frequency and hold times.
Myth #2: You have to have delivered a baby to require pelvic floor PT. (Sub-myth: delivery via C-section doesn’t require pelvic floor PT).
Many women assume that if they haven’t delivered via the vaginal canal that they are probably exempt from pelvic floor issues. Or women who have never undergone childbirth may feel alone, isolated, and unheard if they are experiencing issues such as dyspareunia (pain during intercourse), urinary leakage (incontinence), or urinary frequency/urgency. The truth is that pelvic floor conditions can impact you regardless of your childbearing history! Past experiences, hormone imbalances, life stressors, or pelvic trauma (even old abdominal or pelvic surgeries) can influence the state of the pelvic floor.
And women that have delivered a baby via Cesarean section still had to carry that baby throughout about 9 months of pregnancy! And you bet the pelvic floor had to adapt to accommodate those changes. Not to mention the impact that changes in posture, ligament laxity, and breathing mechanics during pregnancy have on the pelvic floor as well. Check out our blog “What Does a Pelvic PT Actually Do?” for signs that indicate you would benefit from seeing a pelvic floor PT.
Myth #3: It’s too late for me to get help, I’ve let things go on for too long.
This is my favorite myth to bust! Women quite frequently express this tender fear to me at their first appointment, that perhaps they are a lost cause. This couldn’t be further from the truth! No matter what your age or how long you’ve been sucking it up and struggling silently with your symptoms, there is hope. You can always gain power in knowledge about your body, build novel body awareness, commit to some lifestyle changes or form a new habit, start up a new exercise routine, build muscle strength, learn stress reduction and breathing techniques or finally be connected to the right provider to help manage your condition. No matter how bad you think things are or how alone you feel, know that there are actually many other women out there dealing with a very similar issue! You are not alone, it’s never too late-- please reach out!
If you are reading this and weren’t even aware that physical therapy exists for the pelvic floor you are not alone! As a pelvic floor physical therapist, my job is to help bridge the gap between being told to do nothing for the first six weeks after your delivery and then suddenly being cleared for return to all activities but having no clue where to start and feeling lost in your postpartum body.
In a perfect world, it is my (clearly biased) opinion that every woman should have access to an evaluation by a pelvic floor physical therapist sometime around 6-8 weeks postpartum at least to check the state of the pelvic floor after both C-section and vaginal deliveries as well as provide tips regarding nursing positioning, proper lifting and carrying mechanics, and a stepwise exercise progression for return to activity safely. There are however some signs that you should definitely see a pelvic floor physical therapist for more individualized help.
1. You are having accidental urinary or fecal incontinence (leakage) that continues to occur beyond six weeks after delivery. This could be happening during a cough, laugh, or sneeze or during activities such as walking, stairs, bending over, running, or jumping. It could also occur due to a strong overwhelming urge that is difficult to control or without you realizing that leakage is happening. Even if the amount of leakage is just a couple drops, it is still beneficial to address it sooner rather than later, as it is a sign of a larger weakness in the core muscle system. Leakage doesn’t have to be something to laugh off or that is “just part of being a mom”; it is something that can typically be completely resolved.
2. You have a feeling of increased pelvic heaviness/pressure or the sensation of pelvic organs falling down. This is a sensation related to pelvic organ prolapse, which occurs when the bladder, urethra, vaginal wall, uterus, small bowel or rectum is collapsing downward. You can have a greater risk of developing a prolapse after childbirth just due to the amount of pushing and pressure down on your pelvic floor during delivery, as well as some of the hormonal changes that contribute to increased ligament laxity during pregnancy to allow for birth. The good news is that you can learn strategies to help protect your pelvic floor as it is healing in order to avoid continued excess pressure on the pelvic organs. A pelvic floor physical therapist can also teach you how to strengthen the muscles in the pelvic floor and in the core in order to help better support the pelvic organs as well.
3. You are having pain or discomfort when returning to sexual intercourse with your partner. Sometimes this discomfort can be due to scar tissue from perineal tearing or an episiotomy or even C-section incision. Sometimes the discomfort can be due to extra tension in the muscles of the pelvic floor- remember these muscles had to work extra hard all throughout your pregnancy to help hold the baby up- so sometimes they need to be retrained how to relax again. Whatever the cause of the pain, your pelvic floor PT can help figure out the reason behind why the pain is occurring and develop a plan to be able to be intimate with your partner without pain.
Of course, there are other issues postpartum such as diastasis recti (abdominal muscle separation or “mommy tummy”), symphysis pubis dysfunction (SPD), and coccyx (tailbone) pain including other joint pains that can develop due to the repetitive activities you are now performing on an hourly basis as a new mom (think feeding, lifting, carrying) as your body is still healing. A pelvic floor physical therapist can help you address any and all of these potential issues that arise throughout the fourth trimester and the postpartum period. Luckily, even if your medical provider doesn’t refer you to a pelvic floor PT, you can seek out a pelvic floor PT on your own in New York State without a referral. To get started with a free consultation or to book an initial evaluation, contact firstname.lastname@example.org.
Dr. Julie Berube is a pelvic floor physical therapist who is on a mission to revolutionize the standard of healthcare for women in Central New York. She is the owner and founder at LiveWell CNY Physical Therapy, LLC in Syracuse, NY.
Dr. Julie Berube is a pelvic floor physical therapist who is on a mission to revolutionize the standard of healthcare for women in Central New York and the Syracuse area.