Pelvic Floor Physiotherapy 101
Pelvic floor physiotherapy is essential to pregnancy health, birth preparation and postpartum recovery. Toronto pelvic floor physiotherapist, Trang Bùi MScPT of InvigoPhysio, shares her expertise and everything you need to know about your pelvic floor.
Maybe you’ve heard of the so-called pregnancy glow and the beauty of childbirth. While these are wonderful ways to describe a pregnancy experience, what you often don’t hear about are the common pelvic floor problems that can affect many pregnant people and new mothers.
Pelvic pain and pelvic floor dysfunctions are a lot more common than you may think. In fact, 1 in 3 Canadian women are affected by a condition associated with pelvic floor disorder. Pelvic floor issues caused by pregnancy and childbirth are common issues many new mothers suffer with and yet, many people are told these are just normal parts of motherhood. While common, symptoms like pain during sex, inability to control bladder or bowel movement (incontinence), lower back and hip pain, and even pelvic organ prolapse are NOT normal and they can be treated.
What is my pelvic floor?
Your pelvic floor is a group of muscles located at the bottom of your pelvis, like a large hammock hanging from your pubic bone to tailbone, which holds up your bladder, uterus, and bowel.
Responsible for many of your body’s day-to-day functions, your pelvic floor muscles help support your body. When you’re standing, walking, exercising, or carrying laundry up the stairs, your pelvic floor muscles are working for you. From holding your pee until you get home, to supporting your sexual activities, and most importantly, keeping your pelvic organs in place, your pelvic floor is vital to your everyday life and crucial for your pregnancy and birth experience.
You should seek treatment from a pelvic floor physiotherapist if you experience:
Leaking urine, stool or gas when you cough, sneeze, laugh or exercise
Frequent need to pee
Constipation
Persistent lower back, hip pain and body aches and pains during pregnancy and postpartum
Pain during or after sex
Feelings of pressure or heaviness in or around your rectum, vagina, perineum, or pelvis
Bulging or tenting of your stomach when you sit up or carry heavy things
Sensation of something falling out of your vagina
Persistent pelvic pain
What are conditions are treated by a pelvic floor physiotherapist?
Other complicated pelvic floor conditions like interstitial cystitis, endometriosis and irritable bowel syndrome, to name just a few, are connected with your pelvic floor health. Healing your pelvic floor imbalance with pelvic floor physiotherapy is a good treatment option for these complicated, but manageable, conditions.
When is it time to see a pelvic floor physiotherapist?
During pregnancy, your pelvic floor is under a lot of pressure from your baby’s weight growing inside of you. Your abdominal muscles are stretched out and can lose strength, causing decreased support around the midsection area. It’s important to have your pelvic floor checked by a pelvic floor physiotherapist to make sure both your abdominal and pelvic floor have enough strength to support your body’s needs. I typically recommend pregnant people to come in for an assessment at any time after their first trimester. It might seem early but this allows us to check your baseline strength and ability to connect to your pelvic floor and deep core muscles. If you have history of hip or lower back pain, it’s even more important to come in to identify any potential issues and have a program to keep your body strong through many physical changes happening throughout the pregnancy. I then follow up with my clients again at week 34 or 35 to go over exercises to prepare the pelvic floor and body for vaginal birth.
Postpartum internal pelvic floor and DRA check-up usually happen around 6 weeks post-delivery, after your doctor or midwife gives the go ahead. Even if you give birth by C-section, it is still important for you to get your pelvic floor checked as your pelvic floor muscles still went through 9 months of overworking to support your body and your baby.
What is an internal pelvic floor assessment?
An internal assessment performed by a registered pelvic physiotherapist is considered the gold standard for assessing pelvic floor function. Many people associate it with a pap test but the internal exam is much more gentle and not as invasive. I usually go over what will happen during the assessment and what I look for before starting the actual exam. Then with glove and lubricant, I use one finger to enter the vagina and ask you to contract your pelvic floor (most people think of Kegel contraction in this situation). I will then check to see if you’re able to contract the muscles correctly, and if yes, what is the strength and ability to relax the muscles like. The internal exam shouldn’t be painful. If it’s painful, that’s a definite sign that something is going on and needs to be taken care of.
If I don’t experience any symptoms that you listed above, should I still consider coming in?
Remember, your pelvic floor is an incredible group of muscles that are working hard for your body! Your pelvic floor is able to compensate for you even when there is an imbalance so you might not even feel pain or notice any symptoms. The trouble is, when your symptoms aren’t obvious and you put off getting your pelvic floor checked, the dysfunction might get worsened with time. It will take more time and treatments to undo the ‘bad habits’ that your body adapt to help you get by.
Who should get their pelvic floor checked?
Soon-to-be moms - pregnant people who are looking to prepare for their birth experience
Postpartum moms
Moms whose ‘babies’ have left the nest - no matter how long ago you gave birth, whether it was last year, five years ago, fifteen or twenty years ago, getting your pelvic floor checked is an essential part of your health routine
What is included in pelvic physiotherapy treatment?
After the initial assessment, I would sit down with my client to go over the findings and their customized treatment plan that incorporates their health goals, current physical strength and weakness, and current lifestyle. I understand the demands of being a parent and how important it is to make a plan that would fit in with your time whether you have 5 or 30 minutes for daily self-care.
Depending on your body’s unique needs, treatment options at InvigoPhysio can include neurofunctional acupuncture and manual therapy to heal the aches and pains, pelvic floor and core activation exercises, yoga and Pilates-based exercises to further strengthen your lumbo-pelvic region.
In summary, your pelvic floor is a group of muscles essential to your everyday health and critical to your pregnancy, birth experience, and postpartum recovery. A physiotherapist who specializes in pelvic floor health is an important part of your prenatal and postpartum journey. Pelvic floor problems like peeing a little when you laugh or cough, lower back and hip pain, or pain during sex may be common but they are not normal.
Disclaimer: This guest post is meant for informational purposes only and should not replace information or medical advice provided by your primary health provider or healthcare team in hospital.
Written by: Trang Bùi MScPT, a Toronto-based pelvic physiotherapist with a passion for pelvic health. She loves helping people heal their pelvic floor and reconnect with their body through movement therapy. Trang believes that each body requires a unique and holistic treatment plan to reach their wellbeing goals. Learn more about Trang at www.invigophysio.com
Illustration by: Tabatha
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