Pelvic Floor Physical Therapy - What is it and why does it matter?
And what the heck is that thing I'm holding??
Ok, Pelvic Floor PT. Let's start at the beginning and clear some things up. First, I am NOT holding a sex toy. Trust me, there is nothing sexy about that thing I'm holding. Second, this is NOT in scope for me as a practitioner through Functional Nutrition NOR through Integrative Oncology. But it IS an important part of health. Particularly Women's Health.
And honestly, I only saw a Pelvic Floor Doc (yes, they are doctors) a couple of weeks ago for the first time ever. But....I probably should have seen one a very, very long time ago. But who knew what Pelvic Floor was in the 90s anyway??
My purpose today is to share my own personal education, and keep in mind, this isn't in scope for me as a professional. But I feel like it NEEDS to be shared. Men can definitely use pelvic floor therapy too, but for the purposes of today, we'll focus on the ladies.
So....how do you KNOW you need pelvic floor help?
- Low Back Pain
- Pubic Symphyses Pain
- Groin Pain
- Diastases Recti
- Urinary Leakage
- Pelvic Organ Relapse
- Postpartum Rehab
- Pain with Pregnancy, particularly in the groin area
- Pain with intercourse
- Scar tissue after a C-Section
- Unable to orgasm
- Unable to insert a tampon (yep - teenagers, it's ok!!!)
And guys, that's not even a full list. Yes, it's VERY common for women to see pelvic floor because of postpartum issues. That's most of what I hear. "After delivery, I just couldn't hold my pee anymore. I get on the trampoline with the kids, I laugh, I sneeze, and I always pee a little...". THAT is a pelvic floor issue.
Teenagers that can't insert a tampon (and please, use organic cotton, girls - avoid the bleach and the chemicals - that just makes it all worse!), women that aren't interested in sex because it's downright painful, and complete and total pregnancy misery are all great reasons to seek out a Pelvic Floor Physical Therapist.
There are a few great videos from Marie Woerner that goes into more detail about what it is and how it can help here: https://www.woernerphysicaltherapy.com/pelvic-floor-videos/
The second video actually talks about what pelvic floor IS - when you think about your core, that's pelvic floor. When you think about kegels, that's pelvic floor. The thing about kegels though is that most women only do the first HALF. So, when you think of doing a kegel, you think of using that movement/muscle engagement you use to STOP the flow of urine. That's also what we think of when women want to stay "tight". They do kegels! The problem is, they get TOO tight (or they are too tight to begin with), and don't know how to RELAX their pelvic floor. ....Ever been a little constipated and pushed kinda hard? That PUSH is a reverse kegel. And you need to be doing BOTH. Kegel in, all the way up through your transverse abdominals....breathe...hold as long as you can, and then REVERSE slowly and push OUT. That's the full exercise. Most women only do the FIRST step, not even engaging their abs.
Even though pelvic floor therapy is often recommended for postpartum rehab....my personal opinion is that every pregnant woman who CAN should have at least ONE prenatal appointment, probably during second trimester.
During my first appointment, I learned that I've held chronic tension in my core and pelvis for a LONG time. Which means, labor and delivery might be quite painful. My doctor did an external exam to assess alignment of my hips, lower back, etc, (which was pretty darn good thanks to my amazing chiropractor hubby), and then did an INTERNAL exam. Now, I know this is a very personal area. I get it. I'm not talking about the external vagina. I'm talking about INTERNAL. The vaginal canal. And for those thinking "oooh, it sounded like a good idea for my teenage daughter at first, but now I'm not so sure" - TALK with the PT and see how they approach teens. I guarantee you they treat every single patient differently, because every single one of us has different issues, and they will NEVER perform an exam you (or your daughter) are uncomfortable with. Now, I opted for internal assessment since that was directly related to the pain I was experiencing. She performed an exam, explained her findings, and asked if I wanted to proceed with therapy. I agreed. If you have read Mama Natural or any other birthing book, you are probably familiar with perineal massage - this is SORT OF similar. Perineal massage is performed at your "6 o'clock" spot, more or less. My personal pelvic floor internal trigger point treatment went from "3 o'clock" to "9 o'clock". And I experienced three different "layers" of depth as she moved deeper into the canal continuing to perform trigger point therapy.
It was UNCOMFORTABLE. Some spots incurred acute pain. She had me do the full kegel exercise at each of three "clock" spots, and each of the three layers as she went deeper into the pelvis. It was professional, it was uncomfortable, and it was needed. Follow ups are also needed. Because guess what? Child birth is PAINFUL. But this can help MINIMIZE pain and tearing, and I am ALLLLLLL about that.
So what's that thing I'm holding that's obviously not a sex toy (I mean. OUCH). That is a pelvic floor wand from Intimate Rose, a company developed by a Pelvic Floor Doctor to help women work on their pelvic floor AT HOME. I do not recommend buying/using one without receiving proper training from a Pelvic Floor Physical Therapist, but the correct training can help continue treatment between appointments. Additionally, I was given at home stretches, like Happy Baby (look up the yoga pose, guys), where I have to hold the pose for 2 minutes, at LEAST once a day. This is MY experience, and my symptoms. Only you can decide if it's right for you, but to go without sharing felt wrong.
We don't talk enough about our symptoms. We don't talk about constipation, diarrhea, painful sex, depression, anxiety -- forget pregnancy and postpartum. We don't talk about this stuff in GENERAL, and we really should. And I'm doing the best I can to make these conversations NORMAL again. Yes, they can be private, but they should be NORMAL conversations to have. You should never have embarrassment over saying "it hurts to use a tampon" or "sometimes I pee when I laugh".
Nutrition can help. Chiropractic can help. I'm already doing BOTH of those, and when I told my midwife I was a dancer as a kid, and she already knew I'm a lil OCD and definitely Type A, she said, "ooh, you should have at least one appointment. Really. I don't want your labor to be any harder than it has to be".
These are REAL health issues. And to be honest, alot of OBGYNs DON'T talk about it. Because they honestly don't know. I know some wonderful OBGYNs - don't get me wrong. But most are trained in traditional western medicine, and if you talk about pain during sex, or problems during pregnancy, you get a pill. You don't get therapy. Don't be afraid to ASK. Don't be afraid to research or explore. You don't have to hide your pain, I promise. I'm here for questions!
I HOPE you found this helpful, and I hope you are able to seek out a good practitioner for you to help your body heal. Please note this is not meant to be medical advice or medical treatment, and you should talk in detail about the right options for you with your healthcare professional. This is meant to be educational information and a personal testimony only. Thank you!