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What is pelvic physical therapy?

I first met with a pelvic floor PT a few years after having my second child, and only after I was in so much pain I could barely walk, much less run. I should have visited one much sooner, as I suffered extreme pubic symphysis dysfunction. I could easily ‘click’ my pubic symphysis joint in and out of place, experienced extreme pelvic floor pain with running and walking, and also had recurring back spasms. It was not awesome. I did only a short stint with a pelvic floor physical therapist (PT) before becoming pregnant with my third child. 

Following the birth of my son, my OB/GYN referred me to a pelvic floor PT to help me get back on my way towards running. While I didn’t actually start running until about 3-4 months after giving birth, I started doing a basic pelvic floor rehab program a couple of weeks after birth. This basic routine was augmented and directed after meeting with a pelvic floor specialist. Now, I meet with my pelvic floor therapist every two weeks. 

What is your pelvic floor?

The pelvic floor is the network of muscles that supports your entire abdomen and pelvis. This finely tuned network of muscles is kind of shaped like a bowl. During pregnancy and birth, these muscles can be stretched, tightened, weakened, or even sustain tears and build scar tissue. Abdominal muscles accommodate your baby by stretching; this can lead to diastasis rectus abdominus (DRA), which can in turn lead to poor core strength and pelvic and back pain.

Top view: looking down into the pelvis from the top. From: https://learnmuscles.com/glossary/pelvic-floor-muscles-female/

The joints of the pelvis and back are strained during pregnancy as the weight of your baby and belly grow. This affects your posture, and after months of conditioning to a forward-canted posture, it is hard to return to a healthy posture after birth. This is especially true if your core muscles have been weakened, strained, or grown into a lopsided strength distribution. 

During pregnancy, your body releases an abundance of relaxin, the hormone that helps to loosen joints and ligaments. This loosening is what allows your pelvis to expand during childbirth to accommodate an infant. However, these muscles, ligaments, and joints are under a lot of stress, and for a long time during pregnancy. Returning to a healthful, non-pregnant status can require some work.

What happens during a pelvic physical therapy exam?

First, most therapists do an extensive intake process. This includes questionnaires, and importantly, a thorough assessment of the pelvic floor muscles. This usually includes both external and internal exams, though if you are not comfortable, the internal exam can be postponed or skipped entirely. The PT will also likely look at your posture, lower back, and core muscles. The PT will probably discuss any common postpartum issues you may be experiencing or may have experienced. These include incontinence (do you pee when sneezing, coughing, trampolining, or running?), back or pelvic pain or pressure, numbness in your pelvis, perineal pain, or, in some cases, pain with walking or running.

One of the biggest things to keep in mind is that as a patient, it is best to be as clear as possible with your therapist. Don’t be shy! Ask questions, be specific, and be open to discussing anything you may be experiencing.

Some major pelvic floor issues

Pelvic floor dysfunction (PFD): this is when you have overly tight pelvic floor muscles, which cause pain, incontinence, and more.

Pubic symphysis disfunction (PSD): the pubic symphysis joint is the front of your pelvis, where the two halves of your pelvis join. Thanks to the relaxin you had during pregnancy, this joint can be loose and painful after pregnancy. 

Diastasis rectus abdominus (DRA): about ⅔ of women experience diastasis recti after pregnancy. This can be seen and felt as a  ‘splitting’ of the abdominal muscles. Often, women want to do crunches and planks to help tone up their bodies postpartum. Unfortunately, these exercises can exacerbate DRA (so as your pelvic PT for a better program!).

Perineal Pain: this common issue often follows birth where the mother has experienced perineal tearing and the muscles tighten protectively around the area…but then the muscles don’t ever allow themselves to relax.

Pelvic organ prolapse: the pelvic floor muscles are critical in holding the abdominal organs in place. When these muscles are strained to the point where they can no longer perform this function, the organs can drop down into the pelvis, which is not where they are supposed to be. The degree of prolapse can vary. 

Persistent pelvic pain: Pelvic pain can persist or recur years after childbirth. As you age, injuries both treated and overlooked in youth can return with a different expression. Sacroiliac joint pain, pelvic girls pain, groin pain, C-section scar or eipsiotomy scars can also present pain that can be addressed by a pelvic floor PT.

How do I find a pelvic floor PT?

You have many resources available to find a PT that works for you and your insurance plan. Your OBGYN or midwife likely is your first option. They can set you up with a referral if that is needed.

The Academy of the American Physical Therapy Association has a PT locator that will help to sort by location. The International Pelvic Pain Society also has a search tool that can also help you find a provider. 

Most European countries enfold pelvic floor therapy as part of the normal postpartum routine; here in the US we have to do it ourselves, so it’s a lot more work.

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