Pelvic floor Physical Therapy (PFPT) is very similar to traditional physical therapy but it is specialized physical therapy for the pelvic floor. You should care about Pelvic Floor Physical Therapy, because it can remedy so many aches and pains that start in pregnancy and carry through early postpartum and beyond.
What is Pelvic Floor Physical Therapy
Pelvic floor physical therapy is most largely discussed during pregnancy and postpartum but it is also for the general population; both men and women who may have recurring injuries, incontinence, are recovering from a hysterectomy, experiencing pain with sex, chronic constipation, recovery from stomach surgeries and so much more seek care with a PFPT!
Many women are led to believe that incontinence- peeing your pants or leaking gas or stool, after having babies is completely normal and to be expected.
They believe that there is nothing that can be done about it unless she is willing to undergo major surgery or vaginal rejuvenation. But these interventions can potentially cause the problem to become even worse.
When incontinence or pain with sex is brought up to a woman’s doctor they are often instructed to perform more kegels, again this causes more tension and pressure in the pelvic floor that causes the symptoms to worsen. This advice is well-meaning but this will not help will incontinence and painful sex.
The pelvic floor is made up of a bunch of muscles and these muscles need specialized attention and rehabilitation after pregnancy and birth, especially if the birth was traumatic- with tearing beyond stage 2, stitches, epitomes, or instrumental birth. In some cases, the muscles of the pelvic floor do need to be strengthened but more often than not the muscles actually need to be relaxed, released, and lengthened to create less tension and pressure on the pelvic floor.
During physical therapy with a certified pelvic floor physical therapist, your PFPT will interview you asking about your pregnancies, deliveries and what your current pelvic floor dysfunction symptoms are.
Your PFPT will check your stomach for a diastasis recti, she will check the size and the depth as well as the tension that is generated along the linea alba. If you are pregnant she will not check for a diastasis recti.
Then she will ask if you are comfortable with an internal exam. In order to be able to check the strength, tension, and control of the pelvic floor muscles, your PFPT will need to do an internal exam because this is where a large majority of the muscles are located.
The exam itself is much more conservative than a pap smear with your OB. In most cases, she will not need to visually look at your vulva or vagina. She will gently use her gloved fingers to check inside your vaginal canal and ask you to take a few breaths and perform a few kegels to gauge your strength and tendencies. She will also check for prolapse. If you have one she will tell you at what stage it is at and of what organ(s).
Recovery After Pregnancy
Diastasis Recti & Prolapse have become buzzwords recently. Along with the rise in information, diastasis recti and prolapse carry with them an air of fear and avoidance. There are even exercises that claim to be “diastasis and prolapse safe exercises”. But these exercises simply do not exist.
Every woman’s recovery is going to look different in what movements, exercises, load and effort that is appropriate for their diastasis recti or prolapse recovery.
Diastasis recti is a completely normal occurrence. There is nothing a woman can do to avoid it from happening but there are things that are recommended to avoid to not make it worse or create other pelvic floor dysfunctions.
Diastasis recti is necessary to allow for the growth of a pregnant belly. Some level of separation will occur in 100% of pregnancies after 37 weeks of gestation. The diastasis recti is the separation of the abdominal walls along the linea alba, which is a tendon-like structure.
The size of the gap, which is measured by the fingers, does not determine the severity of the diastasis recti. A size 1 finger width separation could potentially be no better functionally than a size 6 finger width separation and sometimes a separation will remain while the diastasis recti is completely healed.
What qualifies a diastasis recti as healed is the ability to manage pressure properly along the linea alba and generate good tension.
To heal a diastasis recti your PFPT will teach you how to manage pressure within the pelvic floor system and properly contract all the muscles that comprise the pelvic floor in unison. The pelvic floor acts like a corset and supports the internal organs allowing them to rise and fall in rhythm with daily activities and exercises.
All of this is controlled by how we breathe and position our bodies. I know this sounds complex but your PFPT will show you all the steps!
It is also a misnomer that by having diastasis recti repaired surgically by stitching the walls of the abdomen together will heal your diastasis recti.
It does make it appear to be closed but just like too many Kegels it can have the opposite effect and certainly does not heal the system of pelvic floor muscles which currently are not working properly to support the pelvic floor.
Prolapse is the descent of an internal organ out of its normal position into the vaginal canal. The descent of the prolapse is measured in stages, ranging from stage 1 to stage 4.
Symptoms often present as heaviness or pressure in the vagina, pain, feeling of extra tissue in the vaginal canal, painful sex, incontinence or can also sometimes present completely asymptomatic.
There are a few different types of prolapse that can occur within the vaginal canal. And it is possible to suffer from more than one. A PFPT will be able to appropriately diagnose you with an internal exam.
Prolapse can not be reversed. It can, however, be supported through the use of pessaries which are fitted by a PFPT or OB and just like in a diastasis recti symptoms of prolapse can be managed through functionally supportive exercise and breath work to manage symptoms.
Again, there are surgeries that promise a repair, it may change the appearance and position of the prolapse but it does not change the function of the pelvic floor. Each woman and each case is unique; only you and your PFPT and OB can determine if and when surgery is a good option for you!
Why should you care?
Many common pelvic floor dysfunctions can be rehabilitated and cease to occur within just a few weeks of Pelvic Floor Physical Therapy. The physical recovery after birth will be much smoother and you more than likely will be far stronger than you were before having children.
If utilized in pregnancy many of the common aches and pains can be much more manageable as you are taught to relax your pelvic floor and how to breathe to expand your diaphragm and pelvic floor to create more space.
Seeing a PFPT in pregnancy will help to relax the muscles that need to stretch for birth, it can help with pelvic girdle pain, rib or back pain, sciatic pain and so much more. It can help reposition the baby by releasing tight muscles, for a smoother delivery and allow the vagina to stretch and be more prepared for vaginal delivery.
If a mother is planning for a Csection, PFPT before and after can help tremendously during the healing process. Csection recovery can be very difficult, many women experience nerve pain along the scar, back pain and difficulty with rotation as the scar tissue pulls across the abdomen.
PFPT will help mobilize the scar which allows the nerve pain to subside and return healthy blood flow, sensation and mobility to the scarred area.
Seeing a PFPT can also help women potentially avoid future injuries and avoid falling for gimmicks that promise a flat belly or to heal a diastasis recti within just a few weeks after giving birth.
Belly binders are hugely popularized but they can have dire outcomes on the health of the pelvic floor and potentially cause pelvic floor injuries that may not have happened otherwise.
In very rare cases will a PFPT recommend a belly binder. Always seek her professional opinion before choosing to use one yourself.
Women recovering from C-sections will use a support as the incisions heals, again this would be a wonderful time to check in with your PFPT to ensure you have the correct one and you are wearing it properly with the only intention being to support the healing of a very vulnerable pelvic floor.
My Experience With Pelvic Floor Physical Therapy
From personal experience, my second pregnancy was much easier in many ways than my first. I started attending pelvic floor physical therapy after the delivery of my first daughter.
I changed the way I exercised, chose movements that were healing and supportive and I became so much stronger than I ever was before having children.
I didn’t suffer from carpal tunnel, sciatic pain, or pelvic girdle pain, as I did in my first pregnancy. My recovery has been much more linear, although it is a little bumpier coupled with the grief.
It is beyond empowering to be informed and understand how to recover my body, what is going on as it heals, and to have a realistic expectation of what recovering from pregnancy and birth truly is like!
Breanna Naccarato is an entrepreneur, a mother of two, and owner of Loved Momma Fitness. Sadly in the spring of 2021, she lost her second daughter at birth and has since transitioned her business from working directly with pregnant and postpartum mothers into bringing more awareness to stillbirth and sharing her knowledge of pelvic floor health and exercise through different outlets. She loves the outdoors and camping with her family in their Adventure Van. Sharing her adventures, joys, and pain with others in hopes to also allow them to find their voice and the words to boldly share their own lives is something that she is very passionate about.