3 Reasons You Should Consider Seeing a Pelvic Floor Physical Therapist Now

Pelvic floor physical therapy (PFPT) is also sometimes called pelvic floor muscle training. It is a non-invasive treatment for pelvic floor issues (1).

Women who experience pelvic organ prolapse, fecal or urinary incontinence, pain with sex, and chronic pelvic pain often seek help from a pelvic floor physical therapist (1). But science also suggests that seeing a pelvic floor physical therapist proactively during pregnancy can prevent some pelvic floor disorders from troubling you postpartum (1).

Here’s everything you need to know about pelvic floor therapy and if it may be right for you:

How does pelvic floor physical therapy work?

PFPT involves education and instruction from a trained physical therapist. PFPT sessions aim to strengthen pelvic muscles and encourage pelvic floor relaxation and coordination (1). So, who needs pelvic floor physical therapy and why?

Pelvic floor muscles are like all other muscles in your body — using them often makes them stronger and more toned (1). If your pelvic floor muscles have average strength and tone, your pelvic organs, such as your vagina, uterus, and bladder, are better supported (1). When the pelvic floor muscles are strong, there is less tension on the ligaments of the pelvis (1). 

It’s common for pelvic floor muscles to stretch during pregnancy and birth, causing many of the postpartum problems you have probably heard about, such as incontinence or pain during sex. The pelvic floor muscles also become weak as the body naturally ages. They can become overly tight with stress or anxiety, and this, too, can cause issues. 

When the pelvic muscles are too loose or too tight, the strain on the pelvic tissues is associated with pelvic floor disorders (2, 3). The many benefits of pelvic floor therapy stem from building pelvic muscle strength and resting tone. By building up strength, you may be able to reverse some of the damage caused by changes to pelvic muscles and ligaments (4). 

Pelvic floor physical therapy in pre-pregnancy and postpartum

Almost half of all people who experience pregnancy and birth will have changes to their pelvic floor muscles (5). About 34% of people in the postpartum period experience some urinary incontinence, and 4% report fecal incontinence (6).

Multiple studies suggest that proactive pelvic floor physical therapy reduces urinary incontinence in the months following birth (7). For this reason, starting pelvic floor therapy as early as the third trimester can be beneficial.

Women are most at risk for pelvic floor disorders in the two years after birth (8). It’s important to note that physical therapy isn’t recommended for all postpartum people because not all people have concerns. 

If you experience pelvic floor disorders like urinary incontinence, anal incontinence, pelvic organ prolapse, and pain with sex (8), PFPT may help you. Obstetric interventions, or things that happened during your birth, may put you at greater risk for pelvic floor disorders and make you more likely to benefit from PFPT.

Surprisingly, studies show that vaginal birth with forceps, episiotomy, and birthing larger than average babies are not correlated with pelvic floor dysfunction, but pushing for over an hour is linked with urinary incontinence (8). If you had a Cesarean birth, you are less likely to have pelvic floor issues (8). 

>> Learn more: How pelvic floor therapy during pregnancy can help

What’s a visit with a pelvic floor physical therapist like?

Your pelvic floor physical therapist will create a treatment plan that’s designed for your specific concerns (1). Most pelvic floor physical therapists will recommend anywhere from four to eight weekly hour-long sessions combined with at-home exercises (1). PFPT can be overwhelming to some people because it can involve vaginal exams. Knowing what to expect ahead of time may make your visit more successful and less anxiety-inducing. 

Your PFPT visit might involve hands-on therapy where the therapist uses their hands to isolate certain pelvic muscles. They may also recommend different therapies that involve machines, called biofeedback or electrical stimulation (1). Your physical therapist will provide education each visit to teach you how to make your muscles stronger and even give you homework to maximize the efficacy of the physical therapy sessions (1). 

Looking for care? Book online with in-network pelvic floor therapists

References:

1. Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics & Gynecology. 2019 Dec;31(6):485–93. 
2. Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstetrics and Gynecology Clinics of North America. 1998 Dec;25(4):723–46. 
3. Ashton-Miller JA, DeLancey JOL. On the Biomechanics of Vaginal Birth and Common Sequelae. Annu Rev Biomed Eng. 2009 Aug;11(1):163–76. 
4. Sampselle C. Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth*1. Obstetrics & Gynecology. 1998 Mar;91(3):406–12. 
5. Handa VL, Nygaard I, Kenton K, Cundiff GW, Ghetti C, et al. Pelvic organ support among primiparous women in the first year after childbirth. Int Urogynecol J. 2009 Dec;20(12):1407–11. 
6. Burgio KL, Borello-France D, Richter HE, FitzGerald MP, Whitehead W, Handa VL, et al. Risk Factors for Fecal and Urinary Incontinence After Childbirth: The Childbirth and Pelvic Symptoms Study. Am J Gastroenterology. 2007 Sep;102(9):1998–2004. 
7. Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay-Smith EJC. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Incontinence Group, editor. Cochrane Database of Systematic Reviews [Internet]. 2017 Dec 22 [cited 2021 Sep 29]; Available from: https://doi.wiley.com/10.1002/14651858.CD007471.pub3
8. Barger MK. Current Resources for Evidence Based Practice, July/August 2021. Journal of Midwifery & Women’s Health. 2021 Jul;66(4):540–7.