Childbirth is a wildly different and beautiful experience for every woman. But some face challenges they didn’t anticipate or imagine during or after birth, like damage to their pelvic floor. Though the pelvic floor is a crucial muscle group that underpins a lot of vital movement and function, it’s not something many of us think about—until, of course, we experience a change.
You can think of the pelvic floor as sort of like a hammock of muscle supporting the reproductive system, holding up the uterus, bladder, and bowel. Like any other muscles, the pelvic floor can experience weakness, overwork, and injury.
And whether you deliver vaginally or by cesarean section, gain a lot of weight or just a little, your pelvic floor muscles may be stretched and pulled to various extremes, causing pain, discomfort, or functional problems including:
- Urinary incontinence, frequency, or urgency
- Fecal incontinence
- Pain with sexual activity
- Pelvic organ prolapse, or the falling out of its normal position
- Scar pain in the lower abdomen from a C-section or near the vaginal opening from vaginal delivery or episiotomy
- Lower back or pelvic pain
- Diastasis recti, or the separation of abdominal muscles
In fact, pelvic-perineal dysfunctions are the most common issues women deal with after giving birth. Nearly all new moms experience some degree of pelvic floor trauma, from bladder issues and weakened muscles in the pelvic area to even discomfort and strain in the hip joints. In most cases, pelvic floor physical therapy can have a huge impact on their healing—and in fact, at Motherfigure, we recommend getting checked out by a pelvic floor physical therapist (PFPT) before birth, and even before conception, because knowledge is power.
Pelvic floor exercises to do during pregnancy
One of the best ways to advocate for your pelvic floor is to get better acquainted with it and learn how to engage your breath to strengthen it.
Here’s how to work on deep belly breathing: Sit cross-legged or in another comfortable position with your back supported. Place your hands on your belly, keep your back and shoulders still, and slowly inhale through the nose to expand your belly. Exhale through the mouth, pulling in your abdomen and drawing the belly button to spine. Then take two tiny breaths, pulling your abdomen back tighter and tighter.
You can also try exercises to target certain muscles throughout the pelvic floor and strengthen them both individually and as a unit.
What to expect from pelvic floor physical therapy
If you’re experiencing difficulties with urination or bowel movements, chronic pelvic pain, or painful intercourse after giving birth, you may want to see a pelvic floor physical therapist. One of the most common symptoms many new moms go through is “leaking,” or the inability to control their urination (which we dive into in greater detail in this article).
Like other physical therapists, pelvic floor PTs are healthcare professionals trained in navigating the root problems and finding solutions through strategic exercises, manual therapy, and patient education, and they have a master’s or doctorate degree in the practice. They specialize in the pelvic floor muscle groups. A couple special certifications to look out for are:
- CAPP-Pelvic: Awarded to licensed physical therapists who pass the three levels of Pregnancy & Postpartum Physical Therapy
- CAPP-OB: Awarded to licensed physical therapists who pass the three levels of the Pelvic Health Physical Therapy program
- WCS: Awarded to licensed physical therapists who specialize in the area of women’s health practice
What do pelvic floor physical therapy sessions entail?
When you visit a pelvic floor physical therapist, some things to anticipate at your visits include:
- An initial conversation: Your PT will want to understand what has brought you to her office.
- A general assessment. Because the pelvic floor (and pregnancy, birth, and carrying babies) can lead to other issues, like low back pain, your PT will likely do an assessment of your body overall, seeing how you walk, how your alignment looks, and so on.
- An internal assessment. Depending on your symptoms, your pelvic floor PT will likely want to do an internal exam. You’ll put on a hospital gown and have draping to cover you. Your provider will likely narrate the process to ensure you’re comfortable, and they will conduct an exam manually to understand what the muscle tissue feels like. They may do biofeedback, a technique where patients can see how the pelvic floor muscles work and where they may be injured.
- Pelvic floor and coordination exercises: We’ve all heard of Kegels, that lifting and squeezing sensation of the pelvic floor. These are great to do throughout pregnancy and afterward to support the function of the pelvic floor, but you may not be doing them the right way. PTs teach the correct way to contract and release pelvic floor muscles (think: draw upward and inward, and hold for a few seconds) without contracting the surrounding ones. They’ll also guide you through breathing and timing methods to make the exercises super effective. The right pelvic floor exercises can loosen too-tight muscles, strengthen weak ones, and enhance flexibility and posture.
- Manual therapy: Applying manual pressure to tight muscles is one way to release them—you’ve probably experienced this before in a massage. The same can be true for pelvic floor muscles. Physical therapists may gently use hands-on therapy to relieve stress and tightness in the lower back, hip, or pelvic floor muscles.
Where can I read first-person accounts and reviews of pelvic PT?
On The Mothership, one of our contributors wrote about her experience pursuing pelvic PT:
Granted, having the therapist point out and work on eliminating some of my trigger points was painful. But with each press of her fingers, I could feel little knots dissolving inside of me. They felt strange, sending little bursts of warmth through me and sometimes referring pain to one of my legs, my back, or my abdomen. It was the weirdest sensation, but as each trigger point melted away, I felt a slight release in tension. The therapist said that meant they were going away. Naturally, with each one that disappeared, she warned that another could form in another spot, so it will take multiple appointments to get rid of all of them. The sessions can be very painful; I walk out of the doctor’s office a little slower but also feeling a little looser inside. She says that means it’s working.
Another woman wrote in Women’s Health about her experience with pelvic floor physical therapy after dealing with urinary problems for more than six months after giving birth to her daughter. Her appointment began like a regular pap smear, except the therapist carefully probed to test the state of her muscles from within the vagina. Her specific problem is actually very common: Her pelvic muscles muscles were too weak, but also too tight at the same time, almost like they had knots similar to those you might get in your neck. So, anytime pressure was applied to her bladder (jumping in a workout class, walking down a hill, coughing too hard), the muscles were too knotted up to constrict in time and stop the stream of urine from escaping. Her therapist assigned daily Kegels and core-strengthening exercises, as well as regular PT visits to check for progress and continue recovering.
For reviews of specific PTs, you can check out reviews for listed providers on the Motherlode.
Where to find a pelvic floor PT
While incontinence and pelvic floor discomfort can feel like something to manage through, pelvic floor physical therapists can help address the underlying cause of symptoms, so leaking isn’t a problem. You can search for a PFPT in your area on the Motherlode.
Like this piece? Subscribe to our newsletter for real stories about women on their journey to motherhood.