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Pelvic Floor Physical Therapy: What It Is, What Really Happens, and Why I Swear By It

physical therapy office

On the topic of "lesser discussed" female needs, pelvic floor therapy is somewhere near the top of the list. If you've heard of it, then I already know why you're here. But if you haven't, then that's an even more important reason to share what I've learned and experienced firsthand! I had never heard of it myself before having it recommended to me after birthing my first baby, and now cannot for the life of me understand how it is not considered a standard of care for women, especially during and after pregnancy. In short, pelvic floor physical therapy treats pain, weakness, and dysfunction in the pelvic floor muscles. This results in chronic pain, incontinence, and a slew of other unpleasant symptoms.

My situation was very unique. I tore my ACL while skiing, and only found out I was pregnant when my doctor ordered an MRI a week later. From there, I was not allowed to get the surgery I needed right away, so I had to work on strengthening my core and other muscles as much as possible to get through my pregnancy, down a good knee. After a very traumatic birth experience nine months later, I had a lot of weakness in my pelvic floor muscles, and was eventually diagnosed with severe diastasis recti (a separation in the abdomen from pregnancy causing a gap, which often appears afterward as a lower belly bulge or "the pooch," as I like to call it.) My knee physical therapist was getting me ready for my upcoming ACL reconstruction surgery, and was worried if I didn't get pelvic floor therapy soon, I'd struggle even more afterward during the challenging recovery which would inevitably call for increased core strength to get around. This was all new to me, but I wanted all the help I could get, so I took her recommendation to see another specialized physical therapist nearby. Full disclosure: my pelvic floor physical therapist was horrified that she had less than 3 months with me before the ACL surgery I booked ASAP, but I credit her completely with why I was able to survive this extremely physically challenging time in my life. She treated me weekly before and after my ACL reconstruction, and exactly six months after having my first baby, I was pregnant again. I continued with pelvic floor therapy throughout the entirety of my second pregnancy and postpartum. All this to say, I have a lot of experience with it, and recommend it to everyone. But I know from quiet conversations with many of my female friends that it is a subject that is intimidating, confusing, and generally comes with much hesitation in wondering if it's really needed or "worth it." I hope the following info will help you feel more educated and allow you to make the best decisions for your life and health! These are all the things I wish I knew then about pelvic floor therapy:

Here's the technical info:

When the pelvic floor muscles are working well, they allow blood flow to connective and muscle tissue, helping improve mobility, movement, and healthy function. The pelvic floor consists of a layer of muscles that stretch from the pubic bone to the tailbone in both men and women. These muscles and connective tissue support the bladder, bowel, and prostate in men, and the bladder, bowel, vagina, and uterus in women. In pregnant women, pelvic floor muscles provide support for the fetus and relax during the natural birthing process. This process of contracting and relaxing helps control bowel and bladder function, and can thus be the reason for dysfunction, especially after having a baby. Namely, contributing to incontinence, constipation, pain during intercourse, or pain in the lower back and all the places core-down.

So what happens during a pelvic floor physical therapy session?

Imagine a workout that takes place inside and out, with both guided and manual work from a specialized therapist. It's essentially a combo platter of stretching, strengthening, coordination, and relaxation exercises, and education in self-management and prevention. More specifically, my first session was a little wild because I had no idea there was an "internal" portion of the visit. Was it awkward? Yes. Did it help? Very much. Did I eventually get over it? Yes. Did my therapist make me feel weird? Not at all. Our sessions consisted of an initial consult to discuss how I'd been feeling and any work I'd been doing on my own to help my recovery, followed by the internal work which involved a "gyno-like" visit of gently stretching and moving the pelvic floor muscles in ways you could not do on your own, and then guided exercises typically focused on my deep core, breathing, overall mobility and real-world functionality. Each session was about an hour long and though it didn't always feel like much work when I was there, I could always recognize the fatigue in areas we worked on the next day. I was diligent about following the provided home exercise program between sessions, and made sure to make time for it around caring for my new baby. As time went on, my therapist adjusted our sessions to suit my progress, and eventually discharged me once I regained my strength and stopped reporting any pain or dysfunction between visits.

Is it worth it?

A thousand times, yes! I have healthcare coverage that reimburses me for up to 40 physical therapy visits per incident, including pregnancy. So even though these types of sessions run ~$200/each depending on where you live, I ultimately paid nothing out of pocket. I have lots of friends whose health insurance does not cover this, and I honestly would consider switching if you want a very pro-family coverage option. (I literally did not pay a penny for my ACL treatment + surgery, or anything relating to my pregnancies whatsoever. It was all included (for way less than traditional insurance) and very straightforward, with real humans that actually answer your phone calls or emails when you have questions. If you want to know more about my experience being a member of a healthcare sharing ministry, just shoot me a DM on Instagram @XtineElise or email me anytime!) But even if you end up covering the costs yourself, I believe there is nothing more worth paying for than your health and wellness, especially after going through something as traumatic as childbirth. My pelvic floor physical therapy totally resolved my postpartum incontinence issues (see also: I no longer had to worry about doing a jumping jack and widdling myself!), pelvic pain and weakness, core instability, and chronic lower back pain. It's literally all gone. You do not need to live in suffering or discomfort for the rest of your lives, friends!

The pressure to "get your pre-baby body back" is already hard enough, but exacerbated when there are tons of issues at play inside that no one can see and you can't totally resolve with time or on your own. As someone who had two c-sections back-to-back, I also got a ton of help with my scar as well. My therapist knew how to move and manipulate the area to break up the scar tissue, resulting in no more pain, tugging, or mobility struggles. I am finally feeling more like my "old self" again thanks to my pelvic floor physical therapy, and I will always shout it from the rooftops: women deserve a high standard of care, and it's time we become educated, share what we learn with our community, and make a commitment to giving the gift of healing to ourselves, as much as we give to others!

* No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Sharing my story and experience is for informational purposes only. Always seek the advice of a physician or qualified health professional with any questions you may have.


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