One of my favorite topics for the past couple of years has been the pelvic floor. It’s true, I adore the pelvic floor.. pelvic bowl.. margarita bowl.. what have you. So after Ceci girl was born, I had my visit with Brea, a local pelvic floor therapist, who I’ve grown to know through our geeky-girl-passion for women’s health. I asked instagram peeps what questions they had for a pelvic floor physical therapist, so without further ado, here they are!

1. What do I expect during a pelvic floor physical therapy session?
   1. Every session is going to look a little different depending on your needs. During the initial evaluation, we spend most of our time getting a detail history, discussing your concerns, and providing education about the pelvic floor and what to expect during treatment. We will take objective measurements to get a good baseline of your function, and it will also help direct our plan of care. A lot of the measurements will resemble traditional physical therapy such as strength testing, mobility, flexibility, etc. Most pelvic health physical therapists are also trained to perform an internal pelvic floor assessment to directly assess the pelvic floor muscles and their function. This gives us a direct look at the source of your dysfunction. Although an internal exam is an excellent resource, it is never necessary. Ultimately, your body, your choice. The internal exam can even be postponed to a later visit due to your comfort, or even your desire to bring a family member in per your preference. 
   2. Treatment sessions will also vary depending on your concerns and how things progress throughout your time in therapy. Types of treatment include patient education, behavioral modifications, bladder re-training, pelvic floor relaxation techniques, pelvic floor muscle downtraining & strengthening, as well as your more “typical” physical therapy activities such as total body strengthening, flexibility, and general mobility concerns. We don’t just look at your pelvic floor! Your core, hips, and other areas of your body can absolutely impact your pelvic health.  We focus on body function as well as mindfulness and “tips & tricks” to help assist in progress towards your goals. Some sessions we may spend a majority of the time discussing techniques, progressing your home program, or learning more about the complexities of the pelvic floor. Some sessions you may be out in the gym breaking a sweat! It all depends on why you’re here, and you will often experience a wide spectrum of treatment types regardless of what brings you through my doors.  

2. Why should I see a pelvic floor physical therapist?
   1. My number one recommendation is to see a pelvic floor physical therapist if you have ANY concern about your pelvic health, and do not be afraid to ask about what is “normal” because although many women’s health problems are “common”, they are NOT normal! Just because your mother or your grandmother may have peed their pants everyday after having a baby, doesn’t make it normal. Just because you are post-partum, intercourse should not be painful. Just because you have endometriosis or interstitial cystitis, and pain may be common, you do not have to continue suffering from pelvic pain!  
   2. Some common concerns I treat include: 
      1. Pelvic pain (during gynecology exams, during intercourse, at rest, etc.), low back pain, hip pain, SIJ dysfunction, pubic symphysis dysfunction, pain and/or dysfunction during pregnancy and/or post-partum, fecal or bladder incontinence (stress, urge, and/or mixed), constipation, difficulty or pain with urination
   3. Some common diagnoses include: 
      1. Dyspareunia (painful intercourse), vaginismus, vulvar vestibulitis, vulvodynia, endometriosis, PCOS, interstitial cystitis, urge/ stress/ mixed urinary and fecal incontinence, prolapse, post-operative care
   4. If you have any questions, feel free to email me directly at BRhein@ssm-select.com and I would be more than happy to help discuss how a pelvic health physical therapist could help you.

3. Should men see a pelvic floor physical therapist?
   1. Absolutely! Men can have some similar complaints as women including pelvic pain, incontinence, constipation, etc. Oftentimes men who undergo prostate cancer treatment, for example, will have complaints and a change in function that could benefit from pelvic floor physical therapy. Pelvic health physical therapists can be hard to find depending on where you live, and those who have been trained to treat men are even scarcer. I would encourage you to do your research and find someone qualified to help you with your concerns. You could visit the APTA Pelvic Health website at https://aptapelvichealth.org/ and you can visit the “For Patients” tab and “Find a Physical Therapist”.

4. Is it too late for middle-aged women to fix the “sneeze-leak” problem, other than medications?
   1. I’ve often been told by my patients they didn’t think they’d make any progress, usually saying something to the effect of “you can’t teach an old dog new tricks”. This is absolutely not the case! Simply speaking, the pelvic floor consists of a group of muscles which can be encouraged to improve in strength, endurance, coordination, and relaxation. Muscles can change, and therefore your symptoms can change. I’ve had a few patients who have noticed significant changes in their leakage after simply discussing how the pelvic floor is supposed to function, and most importantly making sure you have good control and awareness of what those muscles are doing. I’ve had women well into their late-60’s or late-70’s who have made excellent progress with physical therapy. Sometimes, medications are absolutely appropriate. Most physical therapists will work with the patient’s physician to make sure their care aligns well with the referring physician’s plan. For those of you in states with direct access, you can choose to go to a pelvic floor physical therapist without the need for a physician’s referral. In these cases, your physical therapist will provide treatment within their scope of practice, and might make a recommendation to see your doctor if they think additional medical support is necessary to help your progress.

5. Birth prep tips…
   1. Most pregnant women will come to me if they are having active concerns, such as pelvic, SIJ, pubic symphysis, or low back pain. Other pregnant women may be having painful intercourse or urinary incontinence. HOWEVER, you do not need to have an active “problem” to seek out care from a physical therapist. You can absolutely receive physical therapy care for prevention and preparation. Having good control of the pelvic floor, core, and hip muscles will make the birth process much easier. Some general things we may work on, and that you can even get started on at home include:
      1. Perineal stretching to help prepare the external tissues for baby to exit
      2. Hip and pelvic floor stretches to make positioning easier during the birth
      3. Hip and pelvic floor strengthening for optimal function during the birth
      4. Pelvic floor relaxation techniques to ensure that pelvic floor helps guide baby out of the birth canal
      5. Similar techniques for post-partum to help the healing process, and ensure the pelvic floor regains its optimal function
      6. The list goes on! 

Basically everyone with a pelvic floor should see a pelvic floor therapist, you never how how weakness or tightness could be impacting you!

Love and light,

Becca