By Dr. Meghan Haus, PT, DPT
Pelvic floor physical therapy (PFPT) is specialized treatment for conditions of the pelvis, pelvic floor muscles and perineal structures. It is appropriate for a wide number of conditions and we often find that it plays a role in other diagnoses such as hip and low back pain. PFPT is appropriate during pregnancy and postpartum for conditions including low back and pelvic girdle pain, diastasis recti, perineal and c section scar management, urinary leakage and incontinence and tailbone pain. It is also beneficial for conditions that are not related to pregnancy or postpartum such as stress urinary incontinence, pelvic organ prolapse, post operatively for pelvic surgery (for example, hysterectomy) and pain in the pelvic floor region (for example, pain with intercourse)
Your pelvic floor:
Your pelvic floor has three layers of muscles and acts to stabilize your pelvis, provide support for your reproductive organs, assists sexual function and aids in urination and bowel movements. It also plays an important role in the circulatory and lymphatic systems, with proper breathing mechanics and postural support.1
What does a pelvic floor PT do?
A PFPT will do an evaluation including an assessment of posture, gait, range of motion of your spine and hips and breathing mechanics. They will also evaluate the strength of your core, hip and pelvic floor muscles and assess for any muscle tension and pain. Strength and soft tissue assessment may be performed both externally and internally. Internal assessment is only performed when appropriate, when the patient is comfortable and with consent.1 It is important to note that this assessment and pelvic floor treatment methods are intended to be gentle and minimally invasive and typically there are no stirrups or speculum involved! Often internal assessment is not performed until after an initial evaluation and there may be times it is not performed during treatment. Treatment plans may include exercises to strengthen or lengthen your pelvic floor, restore proper breathing mechanics, stretch muscles, strengthen your core and massage therapy techniques for tender point and scar tissue release!1
Up to 90% of women experience low back or pelvic pain during pregnancy and about 30% still have this pain a year postpartum.2 Pain during pregnancy often occurs due to alterations in posture, muscle imbalances and hormonal changes leading to increased mobility in the pelvis and spine. Exercise in pregnancy has been found to improve function and limit sick leave during this period.2 A PFPT can best assess why you may be having pain and prescribe appropriate exercises and manual therapy to mitigate your pain. We can also provide you with techniques to optimize your labor and delivery like perineal stretching, pelvic floor strengthening/lengthening and hip opener activities.5
There is so much a PFPT can do for you in the post-partum period! The physical demands as well as fluctuating hormones in the postpartum period cause excessive joint motion and increased demand on muscles for stability. This can lead to pain due to poor posture or weakened/tight muscles.3 One common complaint after having a baby is a “mom pooch” often caused by diastasis recti abdominis (DRA). During pregnancy, your abdominal wall stretches causing a separation at your linea alba, the connective tissue that joins your rectus abdominis muscles (6 pack abs).1 One study found that 60% of women have DRA at 6 weeks postpartum and 30% continued to demonstrate DRA 1 year postpartum.4 We often see poor muscle activation patterns with decreased recruitment of the deeper core and pelvic floor muscles. This contributes to symptoms like low back pain, urinary incontinence and pelvic organ prolapse. It is important to note that the goal of treatment for DRA is not to eliminate the “gap” between muscles but to teach you how to optimally contract and control your deep core and pelvic floor muscles for decreased risk or incidence of secondary conditions.1 This likely will also improve the appearance of your DRA. A PFPT can also address scar tissue caused by labor and delivery or other pelvic floor dysfunctions following pregnancy and birth.5 C-section births are not excluded from this group, as scar tissue can lead to increased fascial and muscle tension increasing the incidence of LBP, pelvic pain, and dysfunction. A pelvic floor PT can treat a painful or tight scar to help to address these conditions.5
Urinary incontinence (UI) is urinary leakage, increased frequency of urination or both. It impacts women of all ages and stages-athletes, postpartum and post-menopausal. Risk factors include pregnancy, childbirth, menopause, hysterectomy, obesity and age.1 Both a weak pelvic floor and a tight or overactive pelvic floor can contribute to UI. For this reason, it is important to be assessed by a PFPT to determine what the most appropriate treatment exercises and techniques would be for you. It is not just about Kegels! Your PT will design a plan that optimizes activation patterns for you! Additionally, a PFPT can educate you and address behavioral habits that may encourage UI (“just in case” peeing and “power peeing”, for example).1
Pelvic organ prolapse:
Pelvic organ prolapse (POP) is associated with connective tissue laxity and is when the organs located above your pelvic floor drop into your vaginal canal. Risks for this include vaginal delivery, surgery, chronic constipation, systemic disease and menopause. Symptoms are vaginal bulging, pelvic pressure, low backache and bleeding or discharge.1 POP sounds scary, but low grade prolapse is common in women post pregnancy and is often asymptomatic. As with UI, POP can be caused by over or underactive, and non-functioning pelvic floor muscles. Thus an assessment to determine the origin of your symptoms is imperative for effective treatment. Research has demonstrated that pelvic floor exercise and lifestyle advise can reduce prolapse symptoms, stage prolapse and improve QOL.5
As a PFPT I am passionate about educating women that so many of the conditions (like the ones above) are common but do not have to be accepted as “normal” due to childbirth, surgery, or age. If you believe that PFPT would help you, please go to sptny.com to schedule an appointment with me in our Wheatfield or Tonawanda locations!
- Herman and Wallace Pelvic Rehabilitation Institute, Pelvic Floor Level 1: An Introduction to Female Pelvic Floor Function, Dysfunction and Treatment, March 20-21 2021, Remote Course.
- Teyhen, DS et al, Pregnancy and Low Back Pain: Physical Therapy can Reduce Back and Pelvic Pain During and After Pregnancy. JOSPT, 2014 July; 44 (7): 474.
- Musculoskeletal Dysfunction During Pregnancy and After Childbirth. APTA Pelvic Health. 2019. Available at: https://aptapelvichealth.org/2019/10/25/musculoskeletal-dysfunction-during-pregnancy-and-after-childbirth/. Accessed March 30, 2021.
- Sperstand et. al Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. BJSM, 2016, Sept; 50 (17) 1092-6.
- Herman and Wallace Pelvic Rehabilitation Institute, Pelvic Floor Level 2b: Function, Dysfunction and Treatment: Urogynecologic Examination and Treatment Interventions. April 10-11, 2021, Remote Course.