Today, I will cover an uncommon topic which is pelvic floor health for the mother after birth. In Europe, it is routine to discuss pelvic floor strength in postpartum visits and refer to a physiotherapist if there is a concern. In America, mothers accept that they might pee when they laugh or cough after having children or in older age in general. This is common but not normal and can be helped. Incontinence is only one aspect of pelvic floor health. It's also helpful to prepare for childbirth, for anyone that suffers with pain during sex, or with any other discomforts in that area.
Let me know any myths you've heard or questions you have about pelvic floor health.
Also, check out this podcast from the doula organization that trained me.
I interviewed Allison Poole, PT, MSPT about pelvic floor therapy. She works in the building of Birth Roots on State Street in Portland and at Casco Bay PT in Falmouth. We talk about the misconceptions around kegels, what to expect during a visit, and what can be done to alleviate these symptoms.
Q: What is one misconception about pelvic floor health you want to clear up?
A: That it’s for old ladies- I see women from the time before they get pregnant, during pregnancy through menopause. I also see women whom have never had children.
Q: What are these kegel exercises everyone talks about?
A: Treating the pelvic floor consists of much more than kegels. Kegels were developed by Arnold Kegel in 1948 as a way to strengthen the pelvic floor after childbirth. It’s an act of tightening and lifting the muscles of your pelvic floor, like you would to stop the flow of urine. However, it is just one tool, and even after verbal instruction, the majority of women can not perform a kegel correctly.
Q: There is some controversy on the actual benefits of kegels, tell me about your stance on them and when if ever you think they're appropriate?
A: Kegels are effective in training your pelvic floor. If someone has been found to have a weak pelvic floor, kegels can be helpful to train the muscles to contract quickly as well as for long holds. Just like if you had a weak leg muscle after surgery or injury, you would do small muscle tightening first, then as it got more coordinated and stronger you would transition to squats and lunges. The same thing applies to the pelvic floor muscles.
Kegels are often prescribed without evaluation as most OB/GYNs and birth professionals are not trained in assessing pelvic floor muscle function. For instance, if a woman is complaining of leaking, the provider may assume it’s weakness, but in many cases it’s because the muscles are too tight and they can’t contract against a sneeze or cough, and there’s incontinence. So, if she does kegels at every stoplight, she would be making her condition worse, not better.
Q:Tell me some benefits women can expect from using pelvic floor PT before and after birth.
A: Seeing a PT who specializes in pelvic floor rehab and women’s health, including prenatal and postpartum PT can help in so many ways. Prenatally, women can learn safe exercises for the pelvic floor and core muscles as well as breathing techniques to help prevent or speed recovery after childbirth. PT can help treat pain that develops due to pregnancy, including low back and hip pain, pain at the pelvic bone and throughout the ribcage. PT’s are also trained in educating about proper posture and body mechanics to save your neck and back during pregnancy and during those first weeks postpartum.
After childbirth, regardless of vaginal vs. cesarean birth, PT usually starts after the 6-week check-up. A thorough evaluation would address any issues, including pain, assessment of Diastasis Recti (the separation of the belly muscles during pregnancy), pelvic floor weakness/tone and abdominal/back strength and stability. Goals would be set to address specific issues that a woman is experiencing.
Even if a woman is not having specific issues, ideally she should have an evaluation to insure she will not be making a potential issue worse. For example, had a split in her belly muscles, went back to the gym to do abdominal exercises like crunches and planks and actually made that split worse.
Q: Many women do not know what to expect during a visit can you discuss the first visit and exam?
A: An initial evaluation of the pelvic floor can be intimidating for many women. Each evaluation is specific to each person, and sometimes it could be 3 or 4 visits before I assess the pelvic floor directly. I take a thorough medical and birth history and spend a lot of time talking about specific issues you may be experiencing.
After the intake, I check posture, strength of the abdominals, assess for Diastasis Recti and muscle tone/tenderness in the “bike shorts region.”. In the case of a cesarean birth, I also check the scar for sensitivity and mobility. For the pelvic floor assessment, the woman is draped and lying on her back with knees bent, no stirrups. With one finger, I assess tenderness and muscle tone of the vulva, observe you doing a kegel and then assess internally the same things; muscle tone and tenderness as well as the ability to contract and relax the pelvic floor muscles. Finally, I assess for pelvic organ prolapse (descent of the internal organs into the vaginal cavity).
The entire evaluation takes about an hour. I explain the findings and what PT would help with. We make goals together, and I always give something to get started on at home that day. The duration and frequency of appointments is completely individual, and I strive to work around what is realistic for each person. I do not believe in “protocol PT” (ex. 2x/wk x 6wks), but instead what is going to make each person successful in reaching their goals.
Q: Do men ever need pelvic floor therapy?
A: YES! Men are seen for pelvic floor PT for incontinence, pain, issues after prostate cancer among other things. I am not yet trained in seeing men for pelvic floor dysfunction.
Q: Many women think it's normal to urinate a little while laughing/sneezing/etc after birth or when they are older, what are your thoughts on that?
A: IT IS NEVER NORMAL. It is common, 1 out of 3 women will have pelvic floor dysfunction in their lifetime, but it is never normal to leak, EVER. Unfortunately, it is a taboo subject, especially among older women, and therefore no one talks about it, even to their doctor. It takes many women several visits to their doctor before bringing it up. The bottom line is you don’t have to live with these symptoms, and there are very qualified people that are passionate about what they do to help you lead a more active, healthier (drier) life!
Q: Can you include your favorite visual representation of the pelvic floor?
Q:Any funny stories about pelvic floor therapy to lighten the conversation :)
A: To train to become a pelvic floor PT, we have to practice on each other. So on my first day at the Herman & Wallace Institute, I introduced myself to my partner whom I had never met, then within an hour we were on a table performing pelvic floor assessments on each other...it’s quite a way to get to know your colleagues at a whole other level!
Q: Anything else you'd like to add?
A: I see women at Birth Roots on State Street in Portland and at Casco Bay PT in Falmouth. I also am active on social media as MamaPT207 and offer monthly workshops. I welcome emails and phone calls with ANY questions you may have. Thank you!
Allison Poole, PT, MSPT
Pelvic Floor and Women's Health PT
Casco Bay Physical Therapy
367 US Route One, Falmouth, ME 04105
101 State St Suite C, Portland, ME 04102 (Within Birth Roots)
p: (207) 781-5540 f: (207) 781-5542
Facebook & Instagram: mamaPT207