Before pregnancy, you probably didn’t give much thought to your pelvic floor. But it's hugely important: This system of muscle and connective tissue is responsible for supporting your pelvic organs, and pelvic floor muscles also play a key role in continence, sexual arousal and orgasm.[1]
Pelvic floor dysfunction (PFD), which can include pelvic pain, pelvic organ prolapse, or problems with leaking urine or poop,[2] affects an estimated 24 percent of women in the United States.[3] Pelvic floor issues often first appear during or after pregnancy and childbirth. In fact, up to 50 percent of childbearing women have some signs of PFD.
When you're pregnant, your pelvic floor has to support the growing weight of your uterus. During a vaginal delivery, the muscles of the pelvic floor stretch up to three times their normal length.[4] But issues related to PFD can still crop up if you had a C-section, especially if you tried for a vaginal birth first.
Pelvic floor physical therapy has been shown to help all types of pelvic floor disorders.[5] If you're struggling with signs of PFD after childbirth, such as leaking urine when you sneeze or feeling pressure or pain in your vagina, your doctor will likely refer you for pelvic floor physical therapy. Read on for more about the benefits, plus what to expect during your appointment.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a way to strengthen and restore normal functioning to the pelvic floor. Like other types of physical therapy, it involves learning various exercises and techniques taught by a physical therapist.
You’ve probably heard of Kegels, the classic pelvic floor exercise. Perhaps your OB/GYN prescribed a Kegel routine for you during pregnancy or after your postpartum visit. But when it comes to caring for your pelvic floor, Kegels are just one tool (and in fact, depending on your diagnosis, they may not be the best way to improve your symptoms).
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The pelvic floor is part of a complex system, so usually women need a variety of treatment techniques to fully address their symptoms — and that's where a pelvic floor physical therapist can help.
For postpartum moms, pelvic floor physical therapy can improve both immediate symptoms of pelvic floor dysfunction as well as prevent more serious issues from happening later on. Physical therapy during the postpartum period may help prevent pelvic organ prolapse as you age, for example.[6]
What are the benefits of working with a pelvic floor physical therapist?
Pelvic floor physical therapists have training in the normal functioning and disorders of the pelvic floor. They can:
- Give an accurate diagnosis of your pelvic floor issues. Sometimes pregnancy and childbirth can lead to weak pelvic floor muscles, but other times they can contribute to a pelvic floor that is too tight.[7] In addition, a pelvic floor physical therapist can examine you for areas of weakness, signs of poor coordination between the pelvic floor and other important muscles in your core, and tightness or tenderness that may be causing pain or other symptoms.
- Make sure you're performing Kegels correctly. A pelvic floor physical therapist can help make sure you’re engaging the right muscles when doing these exercises.
- Suggest exercises or other treatment options for various pelvic floor issues. For example, weak pelvic floor muscles can cause incontinence issues and pelvic organ prolapse, while a non-relaxing pelvic floor is more often associated with pelvic pain, back and hip pain, painful sex, and difficulty going to the bathroom (though it can also cause incontinence). Depending on the symptoms you're experiencing, your physical therapist can provide an individualized treatment plan to help.
What typically happens during a pelvic floor physical therapy session?
Your first session with a pelvic floor physical therapist will typically consist of a thorough subjective history, an external exam and likely an internal exam.[8]
The internal exam
The internal exam is a little different than your annual exam with your OB. There are usually no stirrups or speculum, for example.
- Your therapist will have you remove pants and underwear, give you a dressing gown to change into and ask you to lay back on an exam table.
- They will insert a gloved finger into your vagina to assess the strength, tone, tenderness and elasticity of your pelvic floor muscles and other connective tissues and nerves.
- Your therapist may have you perform contractions of your pelvic floor and relax your pelvic floor during the internal exam. They may also palpate some of the tissues and ask you about your pain levels. This is to identify tender areas.
The external exam
During the external exam, the therapist will likely check you for:
- Diastasis recti (a condition in which your abdominal muscles are separated)
- Hernias
- Other issues with your abdominal muscles
They will also likely evaluate your spine, hips, pelvis and your sacroiliac joint.
Your treatment plan
From there, your PT will devise an individual treatment plan consisting of various exercises and manual techniques for strengthening, relaxing and/or coordinating your muscle movements better. You’ll do these with your therapist during your session, and then likely be given an exercise routine to continue at home in between sessions.
Your therapist may also use tools like electro stimulation, biofeedback and even vaginal weights. These tools are all helpful for helping you isolate and improve your ability to optimally contract and relax your pelvic floor.
Is pelvic floor physical therapy covered by insurance?
Whether pelvic floor physical therapy is covered will depend on a variety of factors, including your insurance company’s policies as well as those of your physical therapist’s practice.
You can also use funds from a flexible savings account or health savings account to help pay for your sessions.
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