What Is A Pelvic Floor PT And How Can One Help Me?

What Is A Pelvic Floor Physical Therapist And How Can One Help Me?

Barbara Jennings was 6 weeks postpartum when she realized that something wasn’t right. “I had been feeling some pressure in my vagina for a while, but figured it was just a part of the normal healing process after vaginal delivery.” When she finally got the courage to explore a bit, she found something that surprised her. “I felt a smooth lump protruding slightly from the opening of my vagina. I was horrified, and so scared!” 

What Barbara was experiencing is called a pelvic organ prolapse, and it’s not uncommon. A prolapse happens when the vaginal walls become too week (due to things like childbirth) and the organs that are supported by them fall into the pelvic floor basket, sometimes protruding from the vagina. It’s not a curable condition, but can be improved by behavioral modifications, or surgery if necessary.

“After doing a lot of research, I learned that physical therapy could be done to help strengthen the muscles of the pelvic floor and improve symptoms of prolapse”, said Barbara. “I had never even heard of physical therapy for that part of the body, but because I knew I didn’t want surgery, I signed right up.”

Women’s Health PTs are a thing, and they treat everything from prolapse, like Barbara experienced, to pelvic pain, incontinence, back pain, diastasis recti, and more.  But how do you know if you need one? And at what stage of life do you see them?

The first thing to know is that you can see a Woman’s Health PT at anytime. Whether you’re feeling some back pain during pregnancy, want to get checked out after baby arrives, or have difficulty picking up your grandkids without leaking, physical therapy is an option.  Improvements can be seen at any age, and most physical therapists would agree that it should be a first line of defense against leaks and pelvic floor disorders. 

Medications and surgery are often thought of first when it comes to treatment, but when you commit to a physical therapy routine, you’re making the effort to strengthen your body yourself, which can alleviate a lot of pain and/or leakage on it’s own.  If you’re experiencing any kind of pelvic floor, back or hip pain, or if you have bladder leaks, call a physical therapist and get set up an appointment for an examination.

So, what can you expect when you visit? As with most doctor’s visits, you’re PT will ask you lots of questions about your medical history, and the symptoms you’re currently experiencing. You’ll also likely get a musculoskeletal evaluation, and if you are experiencing any pelvic floor dysfunction, an internal exam.

The internal exam sounds scarier than it actually is – rest assured your PT has performed many internal exams and there is nothing to be embarrassed about. It’s a necessary step for them to determine the state of your pelvic floor muscles, and your treatment plan.

Multiple visits are usually required to assess your improvement over time, and to ensure that you are performing your exercises correctly. Treatment is considered complete when your symptoms have improved, although you may need to continue with your treatment plan even after you stop visiting your PT.

If you experience any type of pelvic floor related dysfunction, including pain, bladder leaks, or even if you experience back pain (those muscles are all connected after all!), don’t hesitate to see a PT. It’s often a good first line of defense for these issues and may resolve them better and more naturally than medications or surgery. “Even though my prolapse will never be completely “cured”, I have seen tremendous improvement in my symptoms since I started physical therapy”, says Barbara. “I’m so glad I looked to this option first.”

The Mama Body: Physical Therapy During And After Pregnancy

Physical Therapy During And After Pregnancy

A Guest Blog by Lizanne Pastore PT, MA, COMT

Eighty percent of the bodily changes occurring during pregnancy happen in the first trimester!  Isn’t that astounding?  A woman’s body must adjust quickly to a 40% increase in fluid volume, increased heart and respiratory rates and myriad other changes that may affect us in different ways.  The fluid volume increase, for example, can make our connective tissues weaker—our tendons can get a little mushy and our nerves and blood vessels a bit softer.  This extra fluid and tissue weakening makes us more prone to things like leg swelling, varicosities, tendonitis, carpal tunnel syndrome, or sciatica.  

The hormonal changes in pregnancy play a big role in our metabolism, mood, memory and, of course, ligamentous laxity.  Some pregnant women experience instability not only in the pelvis and hips, but also in the joints of the spine, elbows, and wrists.  Our musculoskeletal system is taxed by these changes even before the baby gets very big.  Then, as baby grows, we might begin seeing rectus abdominis separation (“diastasis recti,”) spinal problems from posture and center of gravity changes, even rib dysfunction as the ribs are forced out and up to make room for belly.  Foot pain from falling arches from the sudden weight gain can occur, and on and on. 

In the pelvic girdle, there is a list of other maladies that can be downright scary to a pregnant or postpartum mama.  And most women are not warned about these potential problems.   Pelvic girdle pain manifesting as coccyx, pubic or sacroiliac joint pain; groin or hip pain; pelvic muscle or nerve pain; plus urinary or fecal incontinence or pelvic organ prolapse are some of the more common things occurring during or after pregnancy. 

After birth, as Mom is busy caring for her newborn and any other children at home—schlepping heavy car seats, strollers, laundry baskets, breastfeeding through the day and night, lifting ever-heavier babies into and out of cribs—she wonders why everything hurts, or why she feels a clicking in her pelvic bones when she lifts her leg!  Well, she is busy performing exceedingly challenging tasks with a sub-optimal musculo-skeletal-neural system (not to mention sleep deprivation!) 

It is well documented that both pregnancy and vaginal birth increases a woman’s risk of developing pelvic organ prolapse or becoming incontinent later in life.  And many women think that leaking during or after birth is “normal” because their friends, moms, aunts, and sisters leaked, plus there are 20 different brands of incontinence pads to choose from in the drugstore, so it “must” be normal.   

But this is wrong; leaking and pelvic organ prolapse is common, but not normal or OK.   The same holds true for back or pelvic pain.  Sure pregnancy puts demands on our bodies, but there is no reason to “put up” with pain, leaking, prolapse, numb hands or legs!  There is a health professional who knows all about this—a physical therapist specially trained in women’s health issues and the pelvic floor.  These PT’s are special – they understand the pregnant and postpartum body and are experts in negotiating a path to health and strength for women with special concerns.

After an initial assessment, which often includes a thorough pelvic muscle exam and possibly even a biofeedback analysis, the woman is prescribed a home program.  This program may include a combination of postural or corrective exercises, motor training or strengthening exercises, bladder and bowel re-training, special instruction to change movement strategies to limit stressors on the body, and even self-care techniques for pain or prolapse, such as self massage for constipation, or gentle inversions for prolapse. 

Wouldn’t it be amazing if every pregnant woman and new mama could have a visit with a PT like this?  Guess what – they can!  If you are reading this article and are pregnant talk about this option with your doctor.  And if you have friends, sisters, aunts and co-workers who might be pregnant or new moms, talk to them about it.  Tell them to ask their doctors for a referral to woman’s health physical therapist!  

Need help finding a qualified PT? Visit the NAFC Specialist Locator to find one in your area.

About the author:  A physical therapist for 29 years, Lizanne has specialized in treating women and men with complex pelvic floor and pelvic girdle issues since 2005.  She has worked primarily in San Francisco and the Bay Area, running a successful private practice for the past 18 years. She writes, lectures, and teaches about pelvic health at the professional and community levels and is currently a board member of the NAFC.  

Postpartum Isn’t Easier When You’re a PT

Postpartum and Physical Therapy

….But it helps

Pregnancy can be a wonderful time of growth, change and anticipation.  As the baby grows, the mother’s body goes through normal musculoskeletal changes.  Muscles in the abdominal and pelvic region stretch, ligaments soften and joints loosen.  Some women handle these changes with ease but others may need the help of a physical therapist to manage pain and incontinence

After the birth of the baby, there are still changes. The postpartum (or post-birth) period can be a beautiful yet challenging time for the mom too. We call this time period the fourth trimester. 

As a PT and mom, I can attest to the challenges I listed above. I can also say that postpartum doesn’t get any easier or feel any better because you’re a PT and you intellectually understand the physiological changes in your body after having a baby. I’m a PT and I know what I need to do for myself and my recovery but knowing what to do and experiencing the discomfort and managing it are different.

Hormones greatly affect the mom emotionally and physically and the pelvic floor muscles are overstretched and weak.  The new mom likely has an incision to care for and may be experiencing some urinary leakage. Ligaments and joints gradually tighten as hormones begin return to pre-pregnancy levels.  However, muscles like the lazy.  If a muscle isn’t exercised it will remain loose and weak.

My prescription for healing after having a baby? Kegels, Tummy Time and Walks.

The secret sauce to making sure that prescription works? Repetition

Understand the purpose of kegeling

The pelvic floor muscles create a natural bowl or basket supporting our pelvic and abdominal organs.  The pelvic floor is vital in controlling our bowel and bladder, is part of our core muscles, assists in our sexual response and must stretch to allow for the baby to slide through the birth canal.

A kegel is the contraction of the pelvic floor muscles. You can learn more about how to kegel, here.

Mimic your baby + get on your tummy

Use that tummy time to kegel from a new position and just take in the moments you have with your new little one.

Try to walk at least once a day

You need socialization and your baby needs it too.  Lucky for you, walking is a great pelvic floor exercise.

At the end of the day, variety and repetition are key. As both a PT and a mom, I’ve found that strengthening the pelvic floor by challenging those muscles in a variety of ways will allow the muscles to become strong enough to maintain dryness. Eventually, your pelvic floor wall will become strong enough for a return to pre-pregnancy activities.

Although we all have to deal with this postpartum changes, being a PT certainly helped me have perspective. I hope this article can help you too!

P.S.  Remember that whatever you do in the name of healing your body is a way to take care of yourself. If you don’t take care of yourself, how could anyone expect you to take care of your little one? Take a deep breath and give these suggestions a try. If you need an extra boost to get you going, read this blog post for inspiration!

 
About the Author, Michelle Herbst:    I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

About the Author, Michelle Herbst:   I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

 

5 PT-Friendly Exercises You Can Do With Your Family

The holiday season can be one of blessings and abundance. But, all the celebration – or the preparation for the celebrations – can leave one feeling stressed. Getting multiple families together can be challenging but the reward is often great.  But what to do about the tension of arranging these get-togethers? How about thinking about exercise as a great stress buster. Instead of reaching for that extra cocktail during your family get together why not think about a few PT-approved exercises you can do with the whole family during the holiday season to stay happy and healthy.

Walk Together

A brisk walk is good for your heart. And as a bonus, you may get a good a heart-to-heart chat in while exercising your muscles, lungs and building bone mass. This is one of the best ways to burn off all those extra calories that are generally consumed this time of year. J

Take a Deep Breath

Deep breathing not only helps keep you relaxed but also keeps your lungs healthy. Germs tend to bred in our climate controlled indoor environments. But, taking a deep breath especially outdoors can help keep the lungs clear and can be calming.

Laugh a little

Laughter can be good for the soul. A good belly roll can relax the shoulders and is a great abdominal and pelvic floor exercise. So, put in a comedy, play some cards or relive old stories about Uncle Dave wearing dirty underwear. Just let the good times roll, or belly roll for that matter.

Head, Shoulders, Knees and Toes, Knees and Toes

Challenge the young and older family members in playing Head, Shoulders, Knees and Toes. Believe me – the preschool-aged family members will know this sing-song of a game. Here is how it goes. Sing … head, shoulder, etc while touching your head, then shoulders with both hands. Each time around sing faster. It will be great to keep the joints moving and is a guaranteed way to get everyone laughing.

Water. Would anyone like water?

Dehydration. Stress. Full tummy. Can be a trifecta that can aggravate incontinence. So, let’s enjoy a glass of water or two to every glass of wine, beer or cocktail. You can do it. You will feel better and your bladder will thank you for it.

Happy Holidays! 

About the Author, Michelle Herbst:   I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

About the Author, Michelle Herbst:  I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

Why You Should Not Be Afraid To See A Physical Therapist For Your Incontinence

Don't Be Afraid To See A Physical Therapist For Incontinence

I’m 38 years old, and I have a prolapsed bladder.  I discovered it after the birth of my first son, and needless to say, it was alarming.  I hadn’t even realized something like this could happen, yet there I was, 6 weeks post-partum at my doctor’s office, with him confirming that, yep, I had a stage 2 cystocele.  I was devastated.  What did this mean?  How would I be able to keep up with my son?  Would it affect me having another child?  Would I experience incontinence because of this?

Determined not to let this problem control my life, I sought out the help of a physical therapist specialized in women’s health.  (Yes, these people exist!)  I’m sure that I was nervous before my appointment, but I shouldn’t have been.  Looking back, all I remember is the understanding, help and wonderful instruction my therapist provided me during this time.  She walked me through my own anatomy, showed me how my muscles all work together to support the pelvic floor, and taught me moves that I could do on my own to help “strengthen things up down there”.  She was my teacher and my cheerleader, who gave me encouragement when I needed it most and helped push me to work hard to see improvements.

And I did improve.  Partly from just the natural recovery process after giving birth, but also due to the help from my weekly sessions with my PT.  Through her I have a much greater understanding of how my pelvic floor and supporting muscles work together and how to keep them strong.  Although I still do have a prolapse (it will never really go away), due to regular exercise that I learned from my PT, it rarely bothers me and I do not experience any incontinence.  I’ve even started running again! 

What I’d like you to take away from my story is this:  If you are experiencing some type of incontinence – no matter what the cause – a trained Physical Therapist can help you.  The exercises and moves that they will teach you may help you alleviate many of the symptoms you experience, and, regardless of treatment, truly should be a part of any plan – whether you are managing with medication, absorbent pads, or even thinking about surgery in the future. 

BE STRONG!  Take control of your life!  Don’t let a prolapse or your incontinence dictate how you live. 

Ready to take the plunge but need help finding a Physical Therapist?  Check out the NAFC Specialist Locator and make your appointment today! 

Incorporating Biofeedback Into Your Pelvic Floor Strengthening Routine

Incorporating biofeedback into your pelvic floor STRENGTHENING routine 

Incorporating biofeedback into your pelvic floor STRENGTHENING routine 

The pelvic floor is made up of a series of muscles that act as a “sling” and support different organs in the body.  Keeping those muscles strong is important for a host of reasons – they help to prevent prolapse, reduce or prevent the symptoms of incontinence, and can even lead to more satisfying sex.  But how do you strengthen those muscles?  And how do you know what you are doing is effective for the long run?

We recommend starting your pelvic floor exercise search with a trained physical therapist (PT) specializing in women’s health.  Your PT will educate you on what muscles connect to the pelvic floor (there are 45!) and how to work all of them in order to keep things working properly.  Many people know of kegels but are unaware of the variety-- and combination-- of workouts that can benefit the pelvic floor. Because the pelvic floor connects to so many other muscles in the body, a workout plan that incorporates strengthening all of these muscles will ensure that you are not placing too big of a strain on any one muscle group.

In addition to specific movements or workouts, your PT may also incorporate biofeedback into your sessions. Biofeedback is a system that reports how well you are performing kegel contractions and can be an indicator of how strong your pelvic muscles are. 

Biofeedback is a great way to actually see how you’re performing in the moment.  Typically, a probe is inserted into the vagina, and sensors on the probe relay information back to a screen or meter.  When you contract your pelvic floor muscles, a reading appears on the screen that tells you how tightly you are squeezing, and for how long. 

Talk to your doctor about biofeedback to see if it might be an option for you.

How Physical Therapy Can Help Your Fitness Plan

Physical Therapy And Fitness: How They Work Together

A guest blog post from Michelle Herbst

Fitness is defined as the condition of being physically fit. There are many parameters to assess one’s fitness level.

Patients often focus on how fast, how far and how long an activity can be completed,  while physical therapists (PTs) focus on the mechanics of a body’s ability.

Because physical therapists are intimately aware of musculoskeletal anatomy and comprehend how the individual joints, muscles and nerves work together synergistically, physical therapy compliments general fitness by designing an individual home care and exercise plan allowing you to go faster, farther and longer.

Because PT’s tend to think beyond the fitness concerns of a patient, many questions are asked about the onset of the injury or current limitation a patient is experiencing. All of these questions help PT’s get to the root of the information that help them formulate an individualized plan.

Some questions patients often here are: How did the injury happen? When and where?  What did you do after the injury? Have you seen your primary care provider? Are you on any medication to treat the injury? How is this effecting your daily activities?

When a particular task, such as walking, has been negatively impacted by injury or illness the physical therapist may measure how fast, how far and how long the patient can complete the activity before symptoms worsen or force the patient to stop.  The information gathered is used to develop an individual treatment plan.

At the end of the day, a PT’s job is to get the patient’s body mechanically fit to complete fitness activities and excel at regular, day-to-day movements that are necessary for an active life.

About the Author, Michelle Herbst:  I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.
About the Author, Michelle Herbst:  I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

Questions to ask your PT at your first appointment

Have you finally made that appointment with a PT to discuss incontinence issues? Kudos to you for seeking out physical therapy for your incontinence problems. As you prepare for your first visit questions may be circling through your mind. That is OK and is normal. Do not feel imitated by asking your physical therapist questions. 

Physical therapists love patients who are engaged and choose to participate in their treatment plan. A fully engaged patient will have better compliance resulting in an improved overall outcome. The end result may be a happier and healthier YOU!  

Carefully chosen questions will allow you to get to know your physical therapist and why they treat patients with your condition. No question truly is a bad question. So, let’s fire away. Below are some questions that should be on your list for your first appointment.

How long have you been practicing physical therapy?

Go ahead and ask - this question will provide a brief history of your therapist.  In order for your physical therapist to have obtained the skills necessary to properly evaluate and treat incontinence she will have been out of physical therapy school for a few years.  

What additional training have you received to evaluate and treat my condition?

It is ok to ask this question – this is your health and you want to be seen by a qualified provider.  Here is the reason why. The skill set necessary to treat incontinence is an advanced skill set that isn’t developed in physical therapy school. Your physical therapist will have taken at least one advanced course past physical therapy school in order to properly evaluate and treat pelvic floor conditions.

How long have you been seeing patients with my problem?

Asking this questions will establish your therapist’s experience with your condition.  Please do not be put off if you are one of her first patients.  Often times, when a therapist is ‘new’ to a condition – that patient is her primary focus and challenge.

What can I do outside of my physical therapy appointments to help in my treatment?

Ka-ching! Great question to ask.  Physical therapists love patients that want to work hard.  Your therapist will LOVE providing you practical and progressive home program to complement your clinic treatments.

Do you have or know of any resources that help me understand my condition?

Again, a great question. The therapist will likely have printed materials to give you but will also have recommendations for valid and reliable online resources.

About the Author, Michelle Herbst:  I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.
About the Author, Michelle Herbst:  I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.