During our adolecent years we experience some pelvic pain due to period cramping, then we have children and experience all sorts of business down there that is too scary to even think about, then there is menopause. Women’s body’s go through a lot and we need to make sure we take care of it. I’m not talking about eating healthy, taking our vitamins and working out. I’m not even talking about annual visits to your gynocologist. I am talking about pelvic physical therapy. Have you heard of it? I hadn’t heard of until I had my first child. Unfortuneately, it took me a second child to consider pelvic PT which I am kicking myself for. I am here to help you ladies out.
I’m going to share my story leading up to why I finally chose to get pelvic pt, the process of my appointment and then I’ll answer all of your questions!
My first child was born via c-section due to an emergency, if you missed that story you can read more about it here. Months after he was born, actually scratch that, it was when I was finding out I was pregnant with my second child tht I heard of pelvic pt. I had talked to my doctor about some issues I had been having and she suggested I go to pelvic physical therapy. Her just saying that made me nervous and uncomfortable. I had never heard of it and didn’t even know what it was, sadly I never gave it a shot. I was in good shape, I was training for a half marathon, I felt good (99% good), I didn’t think I needed pelvic pt.
A few months later I had a successful VBAC with my sweet Noah (you can read more about that here). My body seemed to take much longer to bounce back after second compared to after my first. Since I had them less than two years apart I know it will take longer. Something I did notice was that my abs seemed “deeper”, not necessarily stronger or more defined just kinda of chunky. Turns out I had a little left over diastasis recti and eveyone swears to go see a pelvic pt. During a recent OB appointment in Memphis my doctor again suggested I get pelvic pt. Now that I had been told to get pelvic pt from multiple peope for more than one issue it was time to take action.
Prior to your appointment you fill out a from with your health history and what your concerns are. My appointment included a full body assessment and a post-partum vaginal exam. The appointment started with me standing straight and Amy walked around and took a look at me. Turns out what I felt was “straight” wasn’t exactly so. I was leaning slightly more on my right leg and my left foot wasn’t straight. Next, I lay down on the table. Right away she noticed my left foot was turned out to the left when my right toes were pointing perfectly at the ceiling. Here, I lifted my head up to contract my abs to check on the diastasis recti. It was about 1 cm but an easy fix. When my head was rested Amy noticed my left ribs were sticking out more than my right which was causing my abs to pull more. When we are pregnant our bones soften and change to prepare for childbirth and they don’t always go back!
Once we worked on my ribs and abs she did a the vaginal exam. It is a personal and somewhat invasive experience but it doesn’t feel invasive, your legs aren’t in stirrups or anything. The whole experience was very educational and truly amazing.
Your questions answered // These questions are answered by Amy Moses, PT, DPT, OMT. You can click here to follower her on Facebook.
Q. I’ve never heard of pelvic pt. What exactly is it? Physical therapy for your pelvic area?
A. Pelvic PT is steadily growing in popularity in the US, but it always saddens me when I hear people say they’ve yet to hear of this work. In most developed countries, this type of care is standard and normalized. In France, every woman can get 6 weeks of paid Pelvic PT after every baby (often times, in the mother’s home.)
Essentially, it is care for your pelvic area, and any issues that may arise there. This can include pain in your hips, pelvis, low back, but also bowel and bladder function and sexual health. So many issues can start in the pelvis and affect other parts of our bodies, so it is so important to keep this area of your body healthy and functioning properly. Migraines, restless leg syndrome, fibromyalgia, even toe pain can all be coming from a pelvic floor dysfunction, so we specialize and treat this area in order to help the rest of the body function with balance and wellness.
Q. Is pelvic pt the same as pelvic floor therapy? I was just prescribed that- lot’s of scar tissue from my c-section 9.5 months ago.
A. Yes! Pelvic PT, pelvic floor therapy, pelvic floor rehabilitation, womens’ health, etc are all the same thing. A c-section cuts through layer upon layer of tissue and those layers need to have manual work done after each c-section to help those layers heal and remain as individual layers rather than one scarred down lump. (There is a great video visual on my Facebook page that shows all the layers that are cut for a c-section)
For example: If you had surgery on your knee, your doctor would send you to PT. One of the first things we would address would be the scar. This is because scars HAVE to be mobilized to allow for full mobility and full healing, otherwise they cause more issues. In the knee, this can affect how your knee cap glides every time you walk. In the lower abdomen, this affects how your bladder can fill and hold urine every single minute of your day or how your uterus can expand with your next baby or even with each cycle. I will never understand why this is standard for a knee and not even considered for a C-Section.
Q. Does or can pelvic pt help with signs of uterine prolapse? Coming from a girl who has had two natural child births, one of which I pushed for hours with.
A. Yes!! We help with any type of prolapse: bladder, uterine, rectum, cervix. So often, the body needs help re-pressurizing after pregnancy, meaning your pelvic cavity went through a major shift during pregnancy and labor and the ligaments supporting your organs can get overstretched. With aligning the pelvic bones and assisting the organs back to their normal alignment, we can then strengthen and help stabilize you so that when you lift things, run, or stand for a long time, your body is better able to support you. I had both a bladder and rectal prolapse after my first and both are miniscule now after 3 children. Most women don’t even know they have them, so this is one of the first things we check for in our post partum screening.
Q. Do I go to a specific doctor or my regular gynecologist?
A. You can see any doctor, chiropractor, or nurse practitioner to get a referral for PT, but this differs state to state. Some states don’t require a prescription at all.
Q. Can you do it while pregnant before giving birth?
A. Yes! So many women have pain or issues that come up during pregnancy. Women can have pain (back, hip, pelvic), incontinence (leaking), migraines, restless legs, pain with intercourse, varicose veins in the labia, rib pain, etc. All of these things can and should be addressed and the sooner the better. You shouldn’t enter your labor having already been in pain for weeks or months.
One of the most common issues that can present in pregnancy is called Symphysis Pubis Dysfunction “SPD.” This is a commonly under treated area of pelvic pain for women and too often women are brushed off or told that they’re pregnant so they are going to have aches and pains. The symptoms are often described as “lightning pelvis” or sharp pain in the font of the pubic bone or in either or both of the SI joints or hips or back. It is difficult to walk, get out of bed, get in and out of a car or a chair. This also contributes to the infamous waddle walk. We have patients who come into our clinic in a wheelchair and walk out with no pain or issues.
We can also do work on your pelvis to prepare your body for labor. If muscles are already free to expand and contract as needed and the pelvic bones mobilized to be able to shift as needed, it makes birth so much easier. We even have a biofeedback machine that we can use in the final few weeks of your pregnancy that can tell you which birthing position will potentially be the best for you based on how your muscles respond.
Honestly, I think it should be standard for all pregnant women to have at least an assessment prior to delivery, but especially if you have any pain or issues. Some orthopedic doctors prescribe PT prior to a hip or knee surgery because outcomes are better. Birth should be given the same preparation.
Q. Struggling with incontinence, especially when jumping, since my 9lb baby. Help!
A. This is something we work with all the time. It is never ok to be leaking. This is one of the biggest lies that we as women are told. If you have any form of incontinence: urine, bowel, or gas, you can and should get help with this.
One of my patients told me once that her 6 year old suddenly started leaking at school and the teacher, principal, and pediatrician were all involved to try to figure out why and how to help. She said, “If it’s not ok for my 6 year old to suddenly start leaking, it shouldn’t be ok or ignored that I started leaking when I was 33.” Yes!!! This is your body’s cry for help that you need some help. And the answer is not always to do kegels. Sometimes, your muscles are too tight and on all the time, so kegels can make it worse. Get an assessment from a pelvic PT and throw those pads away!
Q. How long do you continue PT
A. This totally depends on the person. Some patients just need one session to establish a plan and a program and some women come once a month for a year to check in and get a new plan and progress their program. For whatever reason, my patients seem to see a major shift with 6 visits, so I usually say, give me 6 visits and we will decide from there.
Q. Does pelvic PT work if you only have 1cm ?
A. Every woman deserves a post partum checkup. Diastasis Recti is definitely getting a lot of attention these days, and I’m glad because this helps get women through the door for care. However, we check so many things in a pelvic floor assessment and assist you with ways of helping your body to unwind and recover from child bearing and delivery, that it is just so helpful to have someone assess your individual state of post partum and help you from there. Most of my patients love getting this information and it empowers them to feel more confident and knowledgeable about their bodies.
Q. Is it invasive?
A. Part of the exam includes an internal assessment of the vaginal musculature and structures. For most women, this feels daunting before hand, but we aim to make you feel comfortable and safe so that this is not a barrier for you to be able to receive the care that you need.
Q. Any suggestions for tailbone pain?! I have had it ever since I have birth and my daughter just turned 1.
A. Yes! Pelvic PT! Often times tailbone pain is a sign that there has been either an injury to the tailbone or the musculature surrounding it. If a muscle is spasming near the tailbone, it can pull the tailbone with it, causing pain and difficulty sitting properly due to this. Tailbone issues can occur during pregnancy or delivery, but also from a fall or repetitive strain with exercise. This is an issue that can last for years, too. So often, I have women come in for incontinence or some other issue and during the exam, they will mention having pain with sitting on certain chairs from an injury that happened decades ago. They are always floored when their pain improves with just a small adjustment.
Q. Is it normal for urgency to worsen a year after baby? Do I need pelvic PT?
A. Most issues present themselves months after having a baby because weaknesses or areas of dysfunction were likely not addressed early on, so your body may be having a hard time moving forward and adapting to your return to activity, especially as you start chasing and lifting a toddler. The standard post partum OB/Gyn visit is at 6 weeks, but for most women, you are not even aware of what your body can and cannot do at this point. This is why we are trying to help normalize a post partum screening for all women at this point so that your Pelvic PT can monitor you over the next few weeks/months and address issues that can come up months after you have a baby and as you adjust to returning to exercise, work, caring for a growing child, and basically… life.
Q. At what point in resolving Diastasis Recti can you resume more traditional exercises?
A. This depends on your diastasis and how your body is engaging the musculature supporting it. We usually want your diastasis to be less than two finger widths and not very deep before advancing your exercises, but the key is to monitor and observe. If you are “doming” which means pushing outwards through the middle of your abdomen when you do exercises, your activity is too intense for your level of stability. If you are noticing your diastasis is more prominent during exercises or activity, this is a sign that intensity is to high. Always listen and observe your body and if you see your body struggling to maintain stability, reduce intensity and work with your body at the level that it is currently.
Q. Is pelvic pt more helpful than Kegel exercises?
A. I rarely use the term “kegel” when working with my patients because as soon as I do, most women immediately turn on their sphincter muscles which is just a small part of the pelvic floor system. For many women who are attempting to do kegels, the are not only doing them incorrectly, but they can be making the situation worse. The pelvic floor is a network of musculature, bony structures, and organs with ligamentous supports, that is also a dynamic and complicated system. It relies on musculature that can turn on and off constantly throughout the day. For many people, areas of this system can get stuck in the “on” position. If this is the case, it can cause pain, weakness, leaking, posture changes, etc. To tell these women to “do kegels” is like telling someone who has a charlie horse in their hamstring to do hamstring curls. This would only increase their pain and dysfunction. That person needs direct pressure to the charlie horse and gentle stretches and holds to help the spasm to release. The same is true for the pelvic floor musculature. This is why the internal assessment is so important, because it lets you know what your individual muscles are doing and enables you to turn on or off each muscle as needed. After that is determined, we strengthen the areas of weakness and teach the pelvic floor, abdominal musculature, diaphragm, and spinal stabilizers to work together as a unit with your breath to provide a stable and strong base of support for your body to function safely and efficiently.
Q. Heard from girlfriends that all women should go, feedback on women who haven’t had children going?
A. ALL WOMEN SHOULD SEE A PELVIC PT! 🙂 Your friend is right. So much of our daily functions originate in the pelvis so if there is any type of issue there, it can affect us in so many ways. Here are a few things to keep in mind at any age, at any point, regardless of whether or not you have had a baby:
Your period should not be painful. Mild cramps are ok, but taking medication, using a heating pad, migraines, missing work/school/hours…NO. This can and should be addressed ASAP.
Sex should never hurt in any position, at any depth, at any point. You should be orgasming (often and several times.) You can and should be able to ejaculate.
Leaking of any kind needs to be addressed and should not be put off. It is NEVER normal and is always a sign that you need pelvic floor treatment.
Any form of pain in the pelvis, back, hips, tailbone that is not resolving after a few months is a cry for help that something is going on. It won’t hurt to get a pelvic floor assessment to see if it can be affecting another area.
Q. Are there things we can do at home?
A. We get this question a lot, but it totally depends on what is going on. I always say, get an assessment first. Even if you have to drive a long way, learn about your body and what is going on and you will get a plan to take home with you. It is impossible to give a one size fits all program because it absolutely depends on what your body is doing. A lot of this work does occur at home, though. I even train partners to do some of the manual work and this has amazing results, both for helping them to understand what’s going on, and to help them have a role in assisting you when needed. Regardless, once you have a plan, you can do what you need to do to get the healing that you need.
Q. Is it for any age or just women who have not gone through menopause?
A. Any of the issues that we have talked about can occur before, during, or after menopause. It is so important to maintain a healthy pelvic floor during all aspects of your life, especially after menopause. Having bladder, bowel, and sexual health at any stage is one of the most important ways for women to feel independent, empowered, and whole. Always, always, always, advocate for yourself to be in a healthy state of mind and body. And find someone who will listen to you and help you do this.
I want to give Amy a huge thanks for answering all of these questions for all of us women!! THANK YOU!
Although this isn’t a style post I am still wearing clothes! Since I was headed to physical therapy, even if it was only for my pelvic area I still wore workout clothes. I recently bought an outfit from Outdoor Voices for the first time and love how they hold me in. I added shades of pink and marroon to the blueish gray pants.
Live votre rêve!