You’ve never heard of a pelvic floor physical therapist? You are not alone. Obstetricians and gynecologists are often unaware of the help PFPTs can offer their patients. As a sexuality and birth professional pelvic PT’s are one of the most important referrals I make. Women should not have to suffer sexual, urinary, rectal, or pelvic discomfort or pain! A legacy of shame about our genitals may keep women from discussing postpartum and sexual problems. When she does seek help, a woman may also be told nothing can be done, it is in her head, or just a part of having a baby. Because of the easy intimacy of our relationship, clients are likely to discuss pelvic discomfort or pain issues with their birth or postpartum doula. We are an important link in offering women information about pelvic PT.
When is a referral to a pelvic floor PT a good idea? If your client mentions she…
Wets her pants when she coughs, laughs, or sneezes
Has to pee every half hour
Has to run to the bathroom frequently or daily
Can’t use a tampon because it hurts
Dreads sexual touching or intercourse because it is no longer enjoyable and is actually painful
Experiences pelvic pain when picking up her baby or with common daily movements
Things “just don’t feel right down there”
Has orthopedic problems with the pelvis/sacrum/lower back/feet have not improved with traditional treatment
While most of us might think that too “loose” or laxity in the pelvic muscles and ligaments is often the problem, too much “tightness” or stability of the muscles is an equal problem. The muscles and ligaments of the pelvis work together as a dynamic system, which may need treatment postpartum to perform optimally. When you recommend Kegel exercises to your clients, make sure they are spending equal time deliberately tightening and relaxing their vaginal muscles.
Pelvic PT’s specialize in maximizing the function and remedying the dysfunction of the muscles, ligaments, and soft tissue areas of the pelvis. They work with both men and women although the keyword “women’s health” is often used when searching for this specialty. Common referrals to pelvic PT’s are urinary, fecal and flatus (gas) incontinence, getting up at night often to void, constipation, pelvic pain after childbirth, nerve damage, abdominal muscle separation, internal or external cesarean scar pain, and pain with urination, bowel movements, or sexual intercourse. Somatic pain (pain with no known physical cause) that may be the result of emotional, sexual or physical trauma can also be successfully treated. A woman who feels her childbirth was traumatic – even one without obvious physical trauma – may feel somatic pelvic pain. PPT’s may also specialize in sexual problems such as severe genital or pelvic pain and muscle spasms that prevent sexual pleasure and intercourse. Anything less than a feeling of wellness and optimal function in these areas may benefit from evaluation and treatment by a qualified pelvic physical therapist. Even after years with a particular problem, pelvic PT may help.
While we might think that women with lengthy or problematic labors are more likely to have problems postpartum, this would be misleading. Even women with ideal pregnancies and normal labors may have problems postpartum. In my practice I make it a point as my two or three month check in to ask about these issues. “Is everything in your pelvic area back to normal? Are you peeing and pooping okay? Other than needing lubricants when breastfeeding, is your body functioning so that you are without pain or discomfort? If it isn’t, I have some recommendations for you.” Sometimes I just send a “thinking about you” email or letter with local PT information. If my client had any complications whatsoever – cesarean delivery, operative delivery, lengthy second stage, posterior presentation, epidural, episiotomy, or 2nd degree or greater tear, I will inquire specifically and directly about pelvic problems. Every one of my clients who received PPT found out about it through me.
What can a person expect from an evaluation and treatment from a pelvic floor physical therapist? The PT will take a complete history including any pregnancy issues, birth events and feelings, and past or present sexual, urinary and continence problems. The PT will likely do an internal pelvic exam when the patient is ready. This may be at the first visit or several visits later. Understanding exactly where the pain is, pelvic tone and response to different exercises can help the PT focus on the correct therapy.
PFPT’s utilize a variety of therapies depending on the patient’s issues. For postpartum patients, therapy may include exercises, recommendations for changes in daily movements, abdominal binders, TENS units, and education about positioning and posture. If there are issues from an operative delivery (vacuum extraction or forceps), there may be nerve damage. Manual (hands on) therapy techniques can address myofascial restrictions of the pelvic floor and remodeling of scar tissue. PT’s also use biofeedback to help clients become more aware of sensations and to develop controlled responses. For sexual problems, education about optimal sexual functioning and maximizing pleasure and arousal can also be helpful.
As doulas, we are in a place to encourage women to seek high quality and compassionate treatment. We may need to gently coach clients that they not accept pain or altered circumstances as part of having a child. This is not normal. Our reassurance that their condition can be treated by specialists can make a vital difference in the quality of women’s lives for years to come. We can also learn a lot about the pelvis and birth from PFPT’s. When you add your local PPT to your referral list, ask them to make a presentation to your local birth group too.
Good first stop: The Pelvic Guru Explains What PPT Is
Find a Pelvic PT (choose women’s health even though PPTs work with men too)